Provider Demographics
NPI:1699791582
Name:SIKORA, NATHAN DOUGLAS (DC)
Entity type:Individual
Prefix:DR
First Name:NATHAN
Middle Name:DOUGLAS
Last Name:SIKORA
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 1:4001 WHIPPLE AVE NW STE LL01
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:OH
Mailing Address - Zip Code:44718-2977
Mailing Address - Country:US
Mailing Address - Phone:330-479-9345
Mailing Address - Fax:234-458-0920
Practice Address - Street 1:4001 WHIPPLE AVE NW STE LL01
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:OH
Practice Address - Zip Code:44718-2977
Practice Address - Country:US
Practice Address - Phone:330-479-9345
Practice Address - Fax:234-458-0920
Is Sole Proprietor?:No
Enumeration Date:2006-07-14
Last Update Date:2020-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH3528111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2619518Medicaid
OH2619518Medicaid