Provider Demographics
NPI:1629010467
Name:CHILLIES, NIKOLAS RAMONE (DC)
Entity Type:Individual
Prefix:DR
First Name:NIKOLAS
Middle Name:RAMONE
Last Name:CHILLIES
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6253 GOODMAN RD
Mailing Address - Street 2:SUITE A & B
Mailing Address - City:OLIVE BRANCH
Mailing Address - State:MS
Mailing Address - Zip Code:38654-9391
Mailing Address - Country:US
Mailing Address - Phone:662-890-0012
Mailing Address - Fax:662-890-0522
Practice Address - Street 1:6253 GOODMAN RD
Practice Address - Street 2:SUITE A & B
Practice Address - City:OLIVE BRANCH
Practice Address - State:MS
Practice Address - Zip Code:38654-9391
Practice Address - Country:US
Practice Address - Phone:662-890-0012
Practice Address - Fax:662-890-0522
Is Sole Proprietor?:No
Enumeration Date:2006-06-12
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS1092111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS5706402OtherFIRST HEALTH PROVIDER ID
MS0111474OtherCIGNA PROVIDER ID
TN4131570OtherBCBS TN PROVIDER ID
MS701292OtherUNITED HEALTHCARE
MS7696844OtherAETNA PROVIDER ID
MS701292OtherUNITED HEALTHCARE