Provider Demographics
NPI:1720227853
Name:SMITH, NICHOLAS JOHN (DC)
Entity Type:Individual
Prefix:DR
First Name:NICHOLAS
Middle Name:JOHN
Last Name:SMITH
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
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Mailing Address - Street 1:13550 NORTHGATE ESTATES DR
Mailing Address - Street 2:SUITE 210
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80921-7653
Mailing Address - Country:US
Mailing Address - Phone:719-599-8119
Mailing Address - Fax:719-599-0958
Practice Address - Street 1:13550 NORTHGATE ESTATES DR
Practice Address - Street 2:SUITE 210
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80921-7653
Practice Address - Country:US
Practice Address - Phone:719-599-8119
Practice Address - Fax:719-599-0958
Is Sole Proprietor?:Yes
Enumeration Date:2009-02-12
Last Update Date:2009-02-12
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CO6345111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor