Provider Demographics
NPI:1124840046
Name:TAUAESE, NICHOLAS (DC)
Entity type:Individual
Prefix:DR
First Name:NICHOLAS
Middle Name:
Last Name:TAUAESE
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 1:4675 MACARTHUR CT STE 550
Mailing Address - Street 2:
Mailing Address - City:NEWPORT BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92660-8836
Mailing Address - Country:US
Mailing Address - Phone:949-436-7953
Mailing Address - Fax:
Practice Address - Street 1:23161 LAKE CENTER DR STE 130
Practice Address - Street 2:
Practice Address - City:LAKE FOREST
Practice Address - State:CA
Practice Address - Zip Code:92630-6822
Practice Address - Country:US
Practice Address - Phone:949-436-7953
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-10-30
Last Update Date:2024-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA35243111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor