Provider Demographics
NPI:1245356575
Name:BOTT, NICHOLA (DC)
Entity type:Individual
Prefix:DR
First Name:NICHOLA
Middle Name:
Last Name:BOTT
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:992 HIGH RIDGE RD
Mailing Address - Street 2:THIRD FLOOR
Mailing Address - City:STAMFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06905-1616
Mailing Address - Country:US
Mailing Address - Phone:203-321-0000
Mailing Address - Fax:203-322-0300
Practice Address - Street 1:992 HIGH RIDGE RD
Practice Address - Street 2:3RD FLOOR
Practice Address - City:STAMFORD
Practice Address - State:CT
Practice Address - Zip Code:06905-1616
Practice Address - Country:US
Practice Address - Phone:203-321-0000
Practice Address - Fax:203-322-0300
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-21
Last Update Date:2011-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT000873111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT050000873CT01OtherANTHEM
CT050000873CT01OtherANTHEM