Basic Information
| Provider Information | |||||||||
| NPI: | 1649584491 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | NICOLICH CHIROPRACTIC LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 10 RAILROAD AVE | ||||||||
| Address2: | |||||||||
| City: | ROCHELLE PARK | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 076624101 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2012260700 | ||||||||
| FaxNumber: | 2018433012 | ||||||||
| Practice Location | |||||||||
| Address1: | 10 RAILROAD AVE | ||||||||
| Address2: | |||||||||
| City: | ROCHELLE PARK | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 076624101 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2012260700 | ||||||||
| FaxNumber: | 2018433012 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/04/2010 | ||||||||
| LastUpdateDate: | 08/19/2010 | ||||||||
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| AuthorizedOfficialLastName: | NICOLICH | ||||||||
| AuthorizedOfficialFirstName: | DONNA | ||||||||
| AuthorizedOfficialMiddleName: | A | ||||||||
| AuthorizedOfficialTitleorPosition: | CHIROPRACTOR | ||||||||
| AuthorizedOfficialTelephone: | 2012260700 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | DC | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 111N00000X | 38MC00534200 | NJ | Y | 193400000X SINGLE SPECIALTY GROUP | Chiropractic Providers | Chiropractor |
No ID Information.