Provider Demographics
NPI:1649584491
Name:NICOLICH CHIROPRACTIC LLC
Entity Type:Organization
Organization Name:NICOLICH CHIROPRACTIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:DONNA
Authorized Official - Middle Name:A
Authorized Official - Last Name:NICOLICH
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:201-226-0700
Mailing Address - Street 1:10 RAILROAD AVE
Mailing Address - Street 2:
Mailing Address - City:ROCHELLE PARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07662-4101
Mailing Address - Country:US
Mailing Address - Phone:201-226-0700
Mailing Address - Fax:201-843-3012
Practice Address - Street 1:10 RAILROAD AVE
Practice Address - Street 2:
Practice Address - City:ROCHELLE PARK
Practice Address - State:NJ
Practice Address - Zip Code:07662-4101
Practice Address - Country:US
Practice Address - Phone:201-226-0700
Practice Address - Fax:201-843-3012
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-08-04
Last Update Date:2010-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ38MC00534200111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ029441Medicare PIN