Provider Demographics
NPI:1881075216
Name:FOTIEO, NICHOLAS PETER (DC)
Entity type:Individual
Prefix:
First Name:NICHOLAS
Middle Name:PETER
Last Name:FOTIEO
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 1:19 S LA SALLE ST
Mailing Address - Street 2:SUITE #503
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60603-1401
Mailing Address - Country:US
Mailing Address - Phone:312-236-9355
Mailing Address - Fax:312-236-9301
Practice Address - Street 1:19 S LA SALLE ST
Practice Address - Street 2:SUITE #503
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60603-1401
Practice Address - Country:US
Practice Address - Phone:312-236-9355
Practice Address - Fax:312-236-9301
Is Sole Proprietor?:No
Enumeration Date:2015-06-11
Last Update Date:2015-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038012805111NS0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NS0005XChiropractic ProvidersChiropractorSports Physician