Provider Demographics
NPI:1396895447
Name:NICKLAUS, CATHERINE SPENCER
Entity type:Individual
Prefix:DR
First Name:CATHERINE
Middle Name:SPENCER
Last Name:NICKLAUS
Suffix:
Gender:F
Credentials:
Other - Prefix:MS
Other - First Name:CATHY
Other - Middle Name:SPENCER
Other - Last Name:NICKLAUS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DC
Mailing Address - Street 1:2 BROAD ST
Mailing Address - Street 2:SUITE 514
Mailing Address - City:BLOOMFIELD
Mailing Address - State:NJ
Mailing Address - Zip Code:07003-2547
Mailing Address - Country:US
Mailing Address - Phone:973-429-0608
Mailing Address - Fax:
Practice Address - Street 1:2 BROAD ST
Practice Address - Street 2:SUITE 514
Practice Address - City:BLOOMFIELD
Practice Address - State:NJ
Practice Address - Zip Code:07003-2547
Practice Address - Country:US
Practice Address - Phone:973-429-0608
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ38MC00579800111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor