Provider Demographics
NPI:1790162949
Name:CHINZI, NICHOLAS (CTRS)
Entity Type:Individual
Prefix:
First Name:NICHOLAS
Middle Name:
Last Name:CHINZI
Suffix:
Gender:M
Credentials:CTRS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:39102 AYNESLEY ST
Mailing Address - Street 2:
Mailing Address - City:CLINTON TWP
Mailing Address - State:MI
Mailing Address - Zip Code:48038-2718
Mailing Address - Country:US
Mailing Address - Phone:586-322-0869
Mailing Address - Fax:
Practice Address - Street 1:39102 AYNESLEY ST
Practice Address - Street 2:
Practice Address - City:CLINTON TWP
Practice Address - State:MI
Practice Address - Zip Code:48038-2718
Practice Address - Country:US
Practice Address - Phone:586-322-0869
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-04-27
Last Update Date:2015-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI64291225800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225800000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRecreation Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
64291OtherCTRS