Healthcare Provider Details

I. General information

NPI: 1366230278
Provider Name (Legal Business Name): NICHOLAS INSOLIA DC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/29/2025
Last Update Date: 04/29/2025
Certification Date: 04/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12541 OLIVE BLVD
SAINT LOUIS MO
63141-6311
US

IV. Provider business mailing address

2625 BUTTERFIELD RD STE 301N
OAK BROOK IL
60523-1266
US

V. Phone/Fax

Practice location:
  • Phone: 314-227-9388
  • Fax:
Mailing address:
  • Phone: 630-229-4430
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number2022006921
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: