Provider Demographics
NPI:1992731293
Name:GIANNARAS, NICK GEORGE (DC)
Entity type:Individual
Prefix:DR
First Name:NICK
Middle Name:GEORGE
Last Name:GIANNARAS
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 1:811 S OAKLAND ST
Mailing Address - Street 2:SUITE B
Mailing Address - City:GASTONIA
Mailing Address - State:NC
Mailing Address - Zip Code:28054-0408
Mailing Address - Country:US
Mailing Address - Phone:704-861-0224
Mailing Address - Fax:704-861-0225
Practice Address - Street 1:811 S OAKLAND ST
Practice Address - Street 2:SUITE B
Practice Address - City:GASTONIA
Practice Address - State:NC
Practice Address - Zip Code:28054-0408
Practice Address - Country:US
Practice Address - Phone:704-861-0224
Practice Address - Fax:704-861-0225
Is Sole Proprietor?:No
Enumeration Date:2006-06-25
Last Update Date:2009-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2362111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC89-0847EMedicaid
NC89-0847EMedicaid
NC245-3972Medicare ID - Type Unspecified