Healthcare Provider Details

I. General information

NPI: 1649508730
Provider Name (Legal Business Name): NICHOLAS E NOMICOS MD INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/01/2009
Last Update Date: 12/01/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

327 TRINITY AVE
CHOWCHILLA CA
93610-2860
US

IV. Provider business mailing address

327 TRINITY AVE
CHOWCHILLA CA
93610-2860
US

V. Phone/Fax

Practice location:
  • Phone: 559-665-5550
  • Fax: 559-715-4545
Mailing address:
  • Phone: 559-665-5550
  • Fax: 559-715-4545

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License NumberA49055
License Number StateCA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: DR. NICHOLAS EUGENE NOMICOS
Title or Position: OWNER
Credential: MD
Phone: 559-665-5550