Provider Demographics
NPI:1962671107
Name:NICHOLAS P CONSTANTINE DC PA
Entity Type:Organization
Organization Name:NICHOLAS P CONSTANTINE DC PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:NICHOLAS
Authorized Official - Middle Name:P
Authorized Official - Last Name:CONSTANTINE
Authorized Official - Suffix:
Authorized Official - Credentials:D C
Authorized Official - Phone:941-729-3730
Mailing Address - Street 1:312 7TH ST W
Mailing Address - Street 2:
Mailing Address - City:PALMETTO
Mailing Address - State:FL
Mailing Address - Zip Code:34221-5207
Mailing Address - Country:US
Mailing Address - Phone:941-729-3730
Mailing Address - Fax:941-723-9097
Practice Address - Street 1:312 7TH ST W
Practice Address - Street 2:
Practice Address - City:PALMETTO
Practice Address - State:FL
Practice Address - Zip Code:34221-5207
Practice Address - Country:US
Practice Address - Phone:941-729-3730
Practice Address - Fax:941-723-9097
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-21
Last Update Date:2008-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
K4690Medicare PIN