Provider Demographics
NPI:1932310315
Name:OUTLOOK CHIROPRACTIC
Entity Type:Organization
Organization Name:OUTLOOK CHIROPRACTIC
Other - Org Name:THOMAS NICOLAI, DC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:PATRICK
Authorized Official - Last Name:NICOLAI
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:701-797-2941
Mailing Address - Street 1:PO BOX 385
Mailing Address - Street 2:
Mailing Address - City:COOPERSTOWN
Mailing Address - State:ND
Mailing Address - Zip Code:58425-0385
Mailing Address - Country:US
Mailing Address - Phone:701-797-2941
Mailing Address - Fax:701-797-2942
Practice Address - Street 1:605 8TH ST NW
Practice Address - Street 2:
Practice Address - City:COOPERSTOWN
Practice Address - State:ND
Practice Address - Zip Code:58425
Practice Address - Country:US
Practice Address - Phone:701-797-2941
Practice Address - Fax:701-797-2942
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-25
Last Update Date:2008-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND656111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND01713001OtherBCBS GROUP NUMBER