Provider Demographics
NPI:1669583761
Name:MIGLORE, NIKKI M (DC)
Entity type:Individual
Prefix:DR
First Name:NIKKI
Middle Name:M
Last Name:MIGLORE
Suffix:
Gender:F
Credentials:DC
Other - Prefix:DR
Other - First Name:NIKKI
Other - Middle Name:M
Other - Last Name:SIMONSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DC
Mailing Address - Street 1:5533 E BELL RD
Mailing Address - Street 2:SUITE 109
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85254-1228
Mailing Address - Country:US
Mailing Address - Phone:602-788-4200
Mailing Address - Fax:602-788-4208
Practice Address - Street 1:5533 E BELL RD
Practice Address - Street 2:SUITE 109
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85254-1228
Practice Address - Country:US
Practice Address - Phone:602-788-4200
Practice Address - Fax:602-788-4208
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ3902208100000X
AZ7213111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Not Answered111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ70182Medicare ID - Type Unspecified