Provider Demographics
NPI:1649650615
Name:STAPLES, NICO ANTHONY (DC)
Entity type:Individual
Prefix:DR
First Name:NICO
Middle Name:ANTHONY
Last Name:STAPLES
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:708-712-4973
Mailing Address - Fax:678-401-7647
Practice Address - Street 1:125 BARRETT PKWY
Practice Address - Street 2:
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30066-3331
Practice Address - Country:US
Practice Address - Phone:678-324-1016
Practice Address - Fax:678-401-7647
Is Sole Proprietor?:Yes
Enumeration Date:2015-06-04
Last Update Date:2016-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACHIR009463111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor