Provider Demographics
NPI:1104907815
Name:PREGONT, NICHOLAS J (DC)
Entity type:Individual
Prefix:DR
First Name:NICHOLAS
Middle Name:J
Last Name:PREGONT
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:8390 E VIA DE VENTURA
Mailing Address - Street 2:SUITE F114
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85258-3188
Mailing Address - Country:US
Mailing Address - Phone:480-998-7501
Mailing Address - Fax:480-998-5503
Practice Address - Street 1:8390 E VIA DE VENTURA
Practice Address - Street 2:SUITE F114
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85258-3188
Practice Address - Country:US
Practice Address - Phone:480-998-7501
Practice Address - Fax:480-998-5503
Is Sole Proprietor?:No
Enumeration Date:2006-10-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ7499111N00000X
WI33810111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZAZ0942680OtherBLUE CROSS BLUE SHIELD
AZ5607699OtherTHE FIRST HEALTH NETWORK
AZV01216Medicare UPIN
AZ5607699OtherTHE FIRST HEALTH NETWORK