Provider Demographics
NPI:1427667922
Name:PROFOUND HEALTH PLLC
Entity type:Organization
Organization Name:PROFOUND HEALTH PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DOCTOR
Authorized Official - Prefix:
Authorized Official - First Name:NICHOLAS
Authorized Official - Middle Name:
Authorized Official - Last Name:NIDAY
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:704-453-3096
Mailing Address - Street 1:2002 BLUE STREAM LN
Mailing Address - Street 2:
Mailing Address - City:INDIAN TRAIL
Mailing Address - State:NC
Mailing Address - Zip Code:28079-5769
Mailing Address - Country:US
Mailing Address - Phone:704-453-3096
Mailing Address - Fax:
Practice Address - Street 1:703 W SOUTH MAIN ST STE C
Practice Address - Street 2:
Practice Address - City:WAXHAW
Practice Address - State:NC
Practice Address - Zip Code:28173-6919
Practice Address - Country:US
Practice Address - Phone:704-453-3096
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-07-30
Last Update Date:2020-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty