Provider Demographics
NPI:1366791956
Name:MUTHART, NICHOLAS JOHN (DC)
Entity type:Individual
Prefix:DR
First Name:NICHOLAS
Middle Name:JOHN
Last Name:MUTHART
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 1:2801 OCEAN DR
Mailing Address - Street 2:SUITE 205
Mailing Address - City:VERO BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32963-2005
Mailing Address - Country:US
Mailing Address - Phone:772-617-2185
Mailing Address - Fax:
Practice Address - Street 1:2801 OCEAN DR
Practice Address - Street 2:SUITE 205
Practice Address - City:VERO BEACH
Practice Address - State:FL
Practice Address - Zip Code:32963-2005
Practice Address - Country:US
Practice Address - Phone:772-617-2185
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-29
Last Update Date:2016-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH10404111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor