Provider Demographics
NPI:1720095839
Name:KOINOGLOU, NICK GEORGE (DC, FIAMA, DIPL AC)
Entity Type:Individual
Prefix:
First Name:NICK
Middle Name:GEORGE
Last Name:KOINOGLOU
Suffix:
Gender:M
Credentials:DC, FIAMA, DIPL AC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2565 S UNION AVE
Mailing Address - Street 2:
Mailing Address - City:ALLIANCE
Mailing Address - State:OH
Mailing Address - Zip Code:44601-5058
Mailing Address - Country:US
Mailing Address - Phone:330-821-4455
Mailing Address - Fax:330-821-4504
Practice Address - Street 1:2565 S UNION AVE
Practice Address - Street 2:
Practice Address - City:ALLIANCE
Practice Address - State:OH
Practice Address - Zip Code:44601-5058
Practice Address - Country:US
Practice Address - Phone:330-821-4455
Practice Address - Fax:330-821-4504
Is Sole Proprietor?:No
Enumeration Date:2006-08-02
Last Update Date:2024-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH1798111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH34179785200OtherBWC
OH2364409Medicaid
OH4643272OtherAETNA
OH733297Medicaid
OH000000176741Medicaid
OH0886297Medicaid
IL341797852TOtherBCBS OF ILLINOIS
OHIDP1817694OtherOXFORD HEALTH PLAN ID
WV1066011OtherWORKER'S COMP PIN
OH000000139080OtherBCBS
PA721624OtherBCBS
PA721624OtherBC OF WESTERN PA
OH341797852027Medicaid
OH350050794OtherRAILROAD MEDICARE
OH34179785200OtherBWC
OH733297Medicaid
OHIDP1817694OtherOXFORD HEALTH PLAN ID
OH350050794OtherRAILROAD MEDICARE
IL341797852TOtherBCBS OF ILLINOIS