Provider Demographics
NPI:1104920818
Name:NIKOGOSIAN, INETTA V (DN)
Entity type:Individual
Prefix:
First Name:INETTA
Middle Name:V
Last Name:NIKOGOSIAN
Suffix:
Gender:F
Credentials:DN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:333 E IL ROUTE 83
Mailing Address - Street 2:SUITE 106
Mailing Address - City:MUNDELEIN
Mailing Address - State:IL
Mailing Address - Zip Code:60060-4214
Mailing Address - Country:US
Mailing Address - Phone:847-566-0003
Mailing Address - Fax:847-566-5503
Practice Address - Street 1:333 E IL ROUTE 83
Practice Address - Street 2:SUITE 106
Practice Address - City:MUNDELEIN
Practice Address - State:IL
Practice Address - Zip Code:60060-4214
Practice Address - Country:US
Practice Address - Phone:847-566-0003
Practice Address - Fax:847-566-5503
Is Sole Proprietor?:No
Enumeration Date:2006-09-12
Last Update Date:2007-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor