Provider Demographics
NPI:1316918261
Name:NICOTERA, LISA B (DC)
Entity type:Individual
Prefix:DR
First Name:LISA
Middle Name:B
Last Name:NICOTERA
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:395 PLEASANT ST
Mailing Address - Street 2:
Mailing Address - City:NORTHAMPTON
Mailing Address - State:MA
Mailing Address - Zip Code:01060-3914
Mailing Address - Country:US
Mailing Address - Phone:413-584-7787
Mailing Address - Fax:413-584-7778
Practice Address - Street 1:395 PLEASANT ST
Practice Address - Street 2:
Practice Address - City:NORTHAMPTON
Practice Address - State:MA
Practice Address - Zip Code:01060-3914
Practice Address - Country:US
Practice Address - Phone:413-584-7787
Practice Address - Fax:413-584-7778
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA002164111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAU67993Medicare UPIN
MAY45153Medicare ID - Type Unspecified