Provider Demographics
NPI:1720316847
Name:MCCANN, NICKOLAS SCOTT (DC)
Entity Type:Individual
Prefix:DR
First Name:NICKOLAS
Middle Name:SCOTT
Last Name:MCCANN
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 1:3120 W CAREFREE HWY STE 1-328
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85086-3268
Mailing Address - Country:US
Mailing Address - Phone:480-221-0621
Mailing Address - Fax:
Practice Address - Street 1:34406 N. 27TH DR. BUILD 6, SUITE 140
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85085
Practice Address - Country:US
Practice Address - Phone:480-221-0621
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-12-01
Last Update Date:2013-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ8090111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor