Healthcare Provider Details

I. General information

NPI: 1962671107
Provider Name (Legal Business Name): NICHOLAS P CONSTANTINE DC PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/21/2008
Last Update Date: 02/21/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

312 7TH ST W
PALMETTO FL
34221-5207
US

IV. Provider business mailing address

312 7TH ST W
PALMETTO FL
34221-5207
US

V. Phone/Fax

Practice location:
  • Phone: 941-729-3730
  • Fax: 941-723-9097
Mailing address:
  • Phone: 941-729-3730
  • Fax: 941-723-9097

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number
License Number State

VIII. Authorized Official

Name: NICHOLAS P CONSTANTINE
Title or Position: PRESIDENT
Credential: D C
Phone: 941-729-3730