Provider Demographics
NPI:1255539268
Name:NANNINGA, NICOLAS LLLOYD (DC)
Entity type:Individual
Prefix:DR
First Name:NICOLAS
Middle Name:LLLOYD
Last Name:NANNINGA
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 1:4656 NW 86TH STREET
Mailing Address - Street 2:
Mailing Address - City:URBANDALE
Mailing Address - State:IA
Mailing Address - Zip Code:50322-0503
Mailing Address - Country:US
Mailing Address - Phone:515-251-7977
Mailing Address - Fax:515-252-6363
Practice Address - Street 1:4656 NW 86TH STREET
Practice Address - Street 2:
Practice Address - City:URBANDALE
Practice Address - State:IA
Practice Address - Zip Code:50322-0503
Practice Address - Country:US
Practice Address - Phone:515-251-7977
Practice Address - Fax:515-252-6363
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-11
Last Update Date:2007-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA006983111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor