MEDICARE: DR. NICK TRIANDOS D.C.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111NS0005X	Sports Physician Chiropractor	02006	MD
2	111NS0005X	Sports Physician Chiropractor	0104001977	VA

General Provider Information

NPI Number	:	1598770208
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. NICK TRIANDOS D.C.

Provider Business Mailing Address
First Line	:	300 N WASHINGTON ST
Second Line	:	# 710
City	:	ALEXANDRIA
State	:	VA
Zip	:	22314-2530
Country	:	US
Telephone Number	:	703-548-5600
Fax Number	:

Provider Business Practice Location Address
First Line	:	300 N WASHINGTON ST
Second Line	:	# 710
City	:	ALEXANDRIA
State	:	VA
Zip	:	22314-2530
Country	:	US
Telephone Number	:	703-548-5600
Fax Number	:	703-548-6484

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/30/2006
Last Update Date	:	12/17/2019

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