Provider Demographics
NPI:1083421895
Name:NICOLAI, NOAH (DC)
Entity type:Individual
Prefix:DR
First Name:NOAH
Middle Name:
Last Name:NICOLAI
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 1:24759 N LAKE PLEASANT PKWY STE 103
Mailing Address - Street 2:
Mailing Address - City:PEORIA
Mailing Address - State:AZ
Mailing Address - Zip Code:85383-1564
Mailing Address - Country:US
Mailing Address - Phone:623-230-4266
Mailing Address - Fax:
Practice Address - Street 1:24759 N LAKE PLEASANT PKWY STE 103
Practice Address - Street 2:
Practice Address - City:PEORIA
Practice Address - State:AZ
Practice Address - Zip Code:85383-1564
Practice Address - Country:US
Practice Address - Phone:623-230-4266
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-12-16
Last Update Date:2024-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ9182111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor