Provider Demographics
NPI:1912279258
Name:HASTAD, NICHOLAS ADAM (DC)
Entity Type:Individual
Prefix:MR
First Name:NICHOLAS
Middle Name:ADAM
Last Name:HASTAD
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 1:6550 YORK AVE S
Mailing Address - Street 2:303
Mailing Address - City:EDINA
Mailing Address - State:MN
Mailing Address - Zip Code:55435-2347
Mailing Address - Country:US
Mailing Address - Phone:952-941-3311
Mailing Address - Fax:952-944-2004
Practice Address - Street 1:6550 YORK AVE S
Practice Address - Street 2:303
Practice Address - City:EDINA
Practice Address - State:MN
Practice Address - Zip Code:55435-2347
Practice Address - Country:US
Practice Address - Phone:952-941-3311
Practice Address - Fax:952-944-2004
Is Sole Proprietor?:No
Enumeration Date:2012-02-02
Last Update Date:2012-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN5629111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor