Provider Demographics
NPI:1760977292
Name:MISTRY, NICKESH (DC)
Entity Type:Individual
Prefix:
First Name:NICKESH
Middle Name:
Last Name:MISTRY
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 1:13486 HEMLOCK TRL
Mailing Address - Street 2:
Mailing Address - City:FRISCO
Mailing Address - State:TX
Mailing Address - Zip Code:75035-0040
Mailing Address - Country:US
Mailing Address - Phone:469-826-7339
Mailing Address - Fax:
Practice Address - Street 1:1061 N PRESTON RD
Practice Address - Street 2:
Practice Address - City:CELINA
Practice Address - State:TX
Practice Address - Zip Code:75009-3800
Practice Address - Country:US
Practice Address - Phone:469-826-7339
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-06-27
Last Update Date:2024-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX13727111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor