Basic Information
| Provider Information | |||||||||
| NPI: | 1760977292 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MISTRY | ||||||||
| FirstName: | NICKESH | ||||||||
| MiddleName: | |||||||||
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| Credential: | DC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 13486 HEMLOCK TRL | ||||||||
| Address2: | |||||||||
| City: | FRISCO | ||||||||
| State: | TX | ||||||||
| PostalCode: | 750350040 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4698267339 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 187A KIRKHAM CIR | ||||||||
| Address2: | |||||||||
| City: | KYLE | ||||||||
| State: | TX | ||||||||
| PostalCode: | 786408941 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5124050400 | ||||||||
| FaxNumber: | 5124050403 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/27/2018 | ||||||||
| LastUpdateDate: | 06/27/2018 | ||||||||
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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 | 13727 | TX | Y | Chiropractic Providers | Chiropractor |
No ID Information.