Provider Demographics
NPI:1740540426
Name:CAROFILIS, NICHOLAS A (DC)
Entity type:Individual
Prefix:DR
First Name:NICHOLAS
Middle Name:A
Last Name:CAROFILIS
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 1:502 HAMBURG TPKE STE 203A
Mailing Address - Street 2:
Mailing Address - City:WAYNE
Mailing Address - State:NJ
Mailing Address - Zip Code:07470-8446
Mailing Address - Country:US
Mailing Address - Phone:973-747-6346
Mailing Address - Fax:973-942-6339
Practice Address - Street 1:502 HAMBURG TPKE STE 203A
Practice Address - Street 2:
Practice Address - City:WAYNE
Practice Address - State:NJ
Practice Address - Zip Code:07470-8446
Practice Address - Country:US
Practice Address - Phone:973-747-6346
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-05-29
Last Update Date:2020-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ38MC00700900111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor