MEDICARE: DR. THOMAS PATRICK NICOLAI 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	111N00000X	Chiropractor	656	ND
2	111N00000X	Chiropractor	0104556763	VA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	18614	OTHER	ND	BCBS ID
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1598855959
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. THOMAS PATRICK NICOLAI D.C.

Provider Business Mailing Address
First Line	:	493 BLACKWELL RD
Second Line	:	STE 350
City	:	WARRENTON
State	:	VA
Zip	:	20186-2628
Country	:	US
Telephone Number	:	540-347-5900
Fax Number	:

Provider Business Practice Location Address
First Line	:	493 BLACKWELL RD
Second Line	:	STE 350
City	:	WARRENTON
State	:	VA
Zip	:	20186-2628
Country	:	US
Telephone Number	:	540-347-5900
Fax Number	:

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

Provider Enumeration Date	:	10/13/2006
Last Update Date	:	09/26/2016

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