Provider Demographics
NPI:1831246875
Name:STAMOULOS, NICHOLAS (DC)
Entity type:Individual
Prefix:DR
First Name:NICHOLAS
Middle Name:
Last Name:STAMOULOS
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 1:12 MAGNOLIA TER
Mailing Address - Street 2:
Mailing Address - City:STONEHAM
Mailing Address - State:MA
Mailing Address - Zip Code:02180-3070
Mailing Address - Country:US
Mailing Address - Phone:781-367-2157
Mailing Address - Fax:781-641-4483
Practice Address - Street 1:104 MASSACHUSETTS AVE
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:MA
Practice Address - Zip Code:02474-8623
Practice Address - Country:US
Practice Address - Phone:781-641-4482
Practice Address - Fax:781-641-4483
Is Sole Proprietor?:No
Enumeration Date:2007-01-04
Last Update Date:2011-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1830111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA2276060OtherAETNA
MAY36403OtherBLUECROSS BLUESHIELD
MA1612948Medicaid
MA44-00106OtherUNITED HEALTH CARE
MA001830OtherTUFTS HEALTH CARE
MA0024225OtherNEIGHBORHOOD HEALTH PLAN
MA351956OtherHARVARDPILGRIM HEALTHCARE
MASTY45043Medicare ID - Type Unspecified