Provider Demographics
NPI:1285948117
Name:NIKAS, PETER DIMITRIOS
Entity type:Individual
Prefix:MR
First Name:PETER
Middle Name:DIMITRIOS
Last Name:NIKAS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3322 83RD ST
Mailing Address - Street 2:
Mailing Address - City:WOODRIDGE
Mailing Address - State:IL
Mailing Address - Zip Code:60517-3633
Mailing Address - Country:US
Mailing Address - Phone:630-935-7137
Mailing Address - Fax:
Practice Address - Street 1:9933 LAWLER AVE STE 520
Practice Address - Street 2:
Practice Address - City:SKOKIE
Practice Address - State:IL
Practice Address - Zip Code:60077-3724
Practice Address - Country:US
Practice Address - Phone:847-763-1775
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-03
Last Update Date:2017-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038011721111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor