Provider Demographics
NPI:1679647077
Name:CONSTANTINE, NICHOLAS P (D C)
Entity Type:Individual
Prefix:
First Name:NICHOLAS
Middle Name:P
Last Name:CONSTANTINE
Suffix:
Gender:M
Credentials:D C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:312 7TH ST W
Mailing Address - Street 2:
Mailing Address - City:PALMETTO
Mailing Address - State:FL
Mailing Address - Zip Code:34221-5207
Mailing Address - Country:US
Mailing Address - Phone:941-729-3730
Mailing Address - Fax:941-723-9097
Practice Address - Street 1:312 7TH ST W
Practice Address - Street 2:
Practice Address - City:PALMETTO
Practice Address - State:FL
Practice Address - Zip Code:34221-5207
Practice Address - Country:US
Practice Address - Phone:941-729-3730
Practice Address - Fax:941-723-9097
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH 6877111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor