Provider Demographics
NPI:1184733800
Name:MIRRO, NICHOLAS (DC)
Entity type:Individual
Prefix:
First Name:NICHOLAS
Middle Name:
Last Name:MIRRO
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:PO BOX 600084
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75360-0084
Mailing Address - Country:US
Mailing Address - Phone:214-357-7875
Mailing Address - Fax:214-350-1597
Practice Address - Street 1:320 REGAL ROW
Practice Address - Street 2:SUITE 100
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75247-5200
Practice Address - Country:US
Practice Address - Phone:214-357-7875
Practice Address - Fax:972-557-7001
Is Sole Proprietor?:No
Enumeration Date:2006-08-29
Last Update Date:2009-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX8371111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8U8530OtherBLUE CROSS BLUE SHIELD