Provider Demographics
NPI:1659397354
Name:RAPP, NICHOLAS JAMES (DC)
Entity Type:Individual
Prefix:DR
First Name:NICHOLAS
Middle Name:JAMES
Last Name:RAPP
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 1:15170 CHIPPENDALE AVE W
Mailing Address - Street 2:STE 200
Mailing Address - City:ROSEMOUNT
Mailing Address - State:MN
Mailing Address - Zip Code:55068-2770
Mailing Address - Country:US
Mailing Address - Phone:612-840-0374
Mailing Address - Fax:
Practice Address - Street 1:15170 CHIPPENDALE AVE W
Practice Address - Street 2:STE 200
Practice Address - City:ROSEMOUNT
Practice Address - State:MN
Practice Address - Zip Code:55068-2770
Practice Address - Country:US
Practice Address - Phone:612-840-0374
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-14
Last Update Date:2014-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN4788111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN764683600Medicaid
MN764683600Medicaid