Healthcare Provider Details

I. General information

NPI: 1497156269
Provider Name (Legal Business Name): NIKANTH INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/11/2014
Last Update Date: 04/08/2020
Certification Date: 04/08/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

160 N WESTERN AVE
CARPENTERSVILLE IL
60110-1732
US

IV. Provider business mailing address

160 N WESTERN AVE
CARPENTERSVILLE IL
60110-1732
US

V. Phone/Fax

Practice location:
  • Phone: 630-935-2791
  • Fax: 847-426-2450
Mailing address:
  • Phone: 630-935-2791
  • Fax: 847-426-2450

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: TAMARA DENISE ST. JOHN
Title or Position: CHIROPRACTIC PHYSICIAN
Credential:
Phone: 847-426-2420