Basic Information
| Provider Information | |||||||||
| NPI: | 1043629074 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | HEALY | ||||||||
| FirstName: | NICHOLAS | ||||||||
| MiddleName: | BENJAMIN | ||||||||
| NamePrefix: | |||||||||
| NameSuffix: | |||||||||
| Credential: | D.C. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 214 S DILLARD ST | ||||||||
| Address2: | |||||||||
| City: | WINTER GARDEN | ||||||||
| State: | FL | ||||||||
| PostalCode: | 347873523 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7632293537 | ||||||||
| FaxNumber: | 4072876007 | ||||||||
| Practice Location | |||||||||
| Address1: | 214 S DILLARD ST | ||||||||
| Address2: | |||||||||
| City: | WINTER GARDEN | ||||||||
| State: | FL | ||||||||
| PostalCode: | 347873523 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7632293537 | ||||||||
| FaxNumber: | 4072876007 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/04/2014 | ||||||||
| LastUpdateDate: | 07/25/2019 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 111N00000X | CH12432 | FL | Y | Chiropractic Providers | Chiropractor | 111N00000X | 5969 | MN | N | Chiropractic Providers | Chiropractor |
No ID Information.