Provider Demographics
NPI:1992362107
Name:MAASSEN, NICHOLAS REED (DC)
Entity Type:Individual
Prefix:
First Name:NICHOLAS
Middle Name:REED
Last Name:MAASSEN
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 1:2292 TWIGGS CV NW
Mailing Address - Street 2:
Mailing Address - City:KENNESAW
Mailing Address - State:GA
Mailing Address - Zip Code:30152-4208
Mailing Address - Country:US
Mailing Address - Phone:712-470-2122
Mailing Address - Fax:
Practice Address - Street 1:2990 EAGLE DR STE 102
Practice Address - Street 2:
Practice Address - City:WOODSTOCK
Practice Address - State:GA
Practice Address - Zip Code:30189-5575
Practice Address - Country:US
Practice Address - Phone:712-470-2122
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-05-22
Last Update Date:2019-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACHIR010219111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor