Provider Demographics
NPI:1710303532
Name:DIMICHELE, NICHOLAS (DC)
Entity Type:Individual
Prefix:
First Name:NICHOLAS
Middle Name:
Last Name:DIMICHELE
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 1:15851 CAMPFIRE PL
Mailing Address - Street 2:
Mailing Address - City:HUGHESVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20637-2706
Mailing Address - Country:US
Mailing Address - Phone:301-609-2463
Mailing Address - Fax:240-837-9758
Practice Address - Street 1:9809 RHODE ISLAND AVE
Practice Address - Street 2:
Practice Address - City:COLLEGE PARK
Practice Address - State:MD
Practice Address - Zip Code:20740-1423
Practice Address - Country:US
Practice Address - Phone:301-220-1930
Practice Address - Fax:301-220-1906
Is Sole Proprietor?:Yes
Enumeration Date:2014-03-17
Last Update Date:2019-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDSO3771111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor