Healthcare Provider Details

I. General information

NPI: 1558271593
Provider Name (Legal Business Name): NICHOLAS NIETUBYC DC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/10/2026
Last Update Date: 09/10/2026
Certification Date: 09/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8794 BOYNTON BEACH BLVD STE 216
BOYNTON BEACH FL
33472-4469
US

IV. Provider business mailing address

3412 PRIMROSE CT APT 107
PALM BEACH GARDENS FL
33410-2730
US

V. Phone/Fax

Practice location:
  • Phone: 561-364-4111
  • Fax:
Mailing address:
  • Phone: 214-802-9426
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberCH16121
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: