Healthcare Provider Details

I. General information

NPI: 1881514065
Provider Name (Legal Business Name): NICHOLAS LISTRO DC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/17/2026
Last Update Date: 07/17/2026
Certification Date: 07/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7434 PERKINS RD STE 101
BATON ROUGE LA
70808-5197
US

IV. Provider business mailing address

1445 PELICAN CLUB DR
BATON ROUGE LA
70820-5304
US

V. Phone/Fax

Practice location:
  • Phone: 225-367-6164
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number2090
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: