Provider Demographics
NPI:1427145911
Name:CASTO, NICHOLE (DC)
Entity type:Individual
Prefix:
First Name:NICHOLE
Middle Name:
Last Name:CASTO
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 1:15520 ROCKFIELD BLVD
Mailing Address - Street 2:STE A200
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92618-6705
Mailing Address - Country:US
Mailing Address - Phone:949-598-9999
Mailing Address - Fax:949-598-9990
Practice Address - Street 1:1156 EMERALD BAY RD
Practice Address - Street 2:C
Practice Address - City:S LAKE TAHOE
Practice Address - State:CA
Practice Address - Zip Code:96150
Practice Address - Country:US
Practice Address - Phone:530-543-1201
Practice Address - Fax:530-543-1322
Is Sole Proprietor?:No
Enumeration Date:2006-10-06
Last Update Date:2020-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC28482111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1629219126OtherGROUP NPI
CAZZZ53912YOtherBLUE SHIELD
CADC28482OtherCHIROPRACTIC LICENSE
CADA008AMedicare PIN