Provider Demographics
NPI:1932828969
Name:RECUPERO, NICHOLAS CONRAD (DC)
Entity Type:Individual
Prefix:DR
First Name:NICHOLAS
Middle Name:CONRAD
Last Name:RECUPERO
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 1:6360 STONERIDGE MALL RD APT H201
Mailing Address - Street 2:
Mailing Address - City:PLEASANTON
Mailing Address - State:CA
Mailing Address - Zip Code:94588-8058
Mailing Address - Country:US
Mailing Address - Phone:714-380-0027
Mailing Address - Fax:
Practice Address - Street 1:1279 QUARRY LN
Practice Address - Street 2:
Practice Address - City:PLEASANTON
Practice Address - State:CA
Practice Address - Zip Code:94566-8499
Practice Address - Country:US
Practice Address - Phone:925-308-6393
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-23
Last Update Date:2022-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA36209111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor