Provider Demographics
NPI:1770630428
Name:DOINIDIS, NICHOLAS STEVEN (DC)
Entity Type:Individual
Prefix:DR
First Name:NICHOLAS
Middle Name:STEVEN
Last Name:DOINIDIS
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 1:24037 MEADOWBROOK RD
Mailing Address - Street 2:
Mailing Address - City:NOVI
Mailing Address - State:MI
Mailing Address - Zip Code:48375-3456
Mailing Address - Country:US
Mailing Address - Phone:248-348-7530
Mailing Address - Fax:248-348-7766
Practice Address - Street 1:24037 MEADOWBROOK RD
Practice Address - Street 2:
Practice Address - City:NOVI
Practice Address - State:MI
Practice Address - Zip Code:48375-3456
Practice Address - Country:US
Practice Address - Phone:248-348-7530
Practice Address - Fax:248-348-7766
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-04
Last Update Date:2008-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301002994111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0F35108OtherBLUE CROSS BLUE SHIELD OF MICHIGAN
MI350039500OtherRAILROAD MEDICARE
MI2099880Medicaid
MI0F35108Medicare PIN
MI0F35108OtherBLUE CROSS BLUE SHIELD OF MICHIGAN