Provider Demographics
NPI:1790564508
Name:NIKOLAY CHIROPRACTIC LLC
Entity Type:Organization
Organization Name:NIKOLAY CHIROPRACTIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:T
Authorized Official - Last Name:NIKOLAY
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:715-996-1000
Mailing Address - Street 1:117 W UPHAM ST
Mailing Address - Street 2:
Mailing Address - City:MARSHFIELD
Mailing Address - State:WI
Mailing Address - Zip Code:54449-1458
Mailing Address - Country:US
Mailing Address - Phone:715-996-1000
Mailing Address - Fax:715-384-7910
Practice Address - Street 1:117 W UPHAM ST
Practice Address - Street 2:
Practice Address - City:MARSHFIELD
Practice Address - State:WI
Practice Address - Zip Code:54449-1458
Practice Address - Country:US
Practice Address - Phone:715-996-1000
Practice Address - Fax:715-384-7910
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-09-22
Last Update Date:2023-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty