Provider Demographics
NPI:1851434989
Name:NICOLETTI, BRIAN R (DC)
Entity Type:Individual
Prefix:DR
First Name:BRIAN
Middle Name:R
Last Name:NICOLETTI
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 1:955 YONKERS AVE
Mailing Address - Street 2:SUITE 12
Mailing Address - City:YONKERS
Mailing Address - State:NY
Mailing Address - Zip Code:10704-3060
Mailing Address - Country:US
Mailing Address - Phone:914-237-6440
Mailing Address - Fax:914-803-0153
Practice Address - Street 1:955 YONKERS AVE
Practice Address - Street 2:SUITE 12
Practice Address - City:YONKERS
Practice Address - State:NY
Practice Address - Zip Code:10704-3060
Practice Address - Country:US
Practice Address - Phone:914-237-6440
Practice Address - Fax:914-803-0153
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX3366111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYX18871Medicare UPIN
NYX18871Medicare ID - Type Unspecified