Provider Demographics
NPI:1962583021
Name:DRAGONETTE, NICHOLAS J
Entity type:Individual
Prefix:DR
First Name:NICHOLAS
Middle Name:J
Last Name:DRAGONETTE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:S. 3405 ORCHARD PARK RD
Mailing Address - Street 2:
Mailing Address - City:ORCHARD PARK
Mailing Address - State:NY
Mailing Address - Zip Code:14127-1618
Mailing Address - Country:US
Mailing Address - Phone:716-675-0515
Mailing Address - Fax:716-674-0394
Practice Address - Street 1:S. 3405 ORCHARD PARK RD
Practice Address - Street 2:
Practice Address - City:ORCHARD PARK
Practice Address - State:NY
Practice Address - Zip Code:14127-1618
Practice Address - Country:US
Practice Address - Phone:716-675-0515
Practice Address - Fax:716-674-0394
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-17
Last Update Date:2022-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX3804111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor