Provider Demographics
NPI:1518006626
Name:STYCHNO, NESTOR A (DC)
Entity type:Individual
Prefix:
First Name:NESTOR
Middle Name:A
Last Name:STYCHNO
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 1:2103 NILES CORTLAND RD
Mailing Address - Street 2:
Mailing Address - City:WARREN
Mailing Address - State:OH
Mailing Address - Zip Code:44484
Mailing Address - Country:US
Mailing Address - Phone:330-544-3737
Mailing Address - Fax:330-544-3904
Practice Address - Street 1:2103 NILES CORTLAND RD
Practice Address - Street 2:
Practice Address - City:WARREN
Practice Address - State:OH
Practice Address - Zip Code:44484
Practice Address - Country:US
Practice Address - Phone:330-544-3737
Practice Address - Fax:330-544-3904
Is Sole Proprietor?:No
Enumeration Date:2007-02-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH139111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0608444Medicaid
OHST0385742Medicare ID - Type Unspecified
OH0608444Medicaid