Provider Demographics
NPI:1760449417
Name:NICOLAI, MICHAEL KENNETH (DC)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:KENNETH
Last Name:NICOLAI
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 1:207 1ST AVE S STE A
Mailing Address - Street 2:
Mailing Address - City:NEW ROCKFORD
Mailing Address - State:ND
Mailing Address - Zip Code:58356-1800
Mailing Address - Country:US
Mailing Address - Phone:701-947-2121
Mailing Address - Fax:701-947-2012
Practice Address - Street 1:207 1ST AVE S
Practice Address - Street 2:
Practice Address - City:NEW ROCKFORD
Practice Address - State:ND
Practice Address - Zip Code:58356-1807
Practice Address - Country:US
Practice Address - Phone:701-947-2121
Practice Address - Fax:701-947-2012
Is Sole Proprietor?:No
Enumeration Date:2006-04-27
Last Update Date:2023-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND573111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND1458577Medicaid
ND17556OtherBLUE CROSS PROVIDER#
NDN17556Medicare ID - Type Unspecified