Healthcare Provider Details

I. General information

NPI: 1720095839
Provider Name (Legal Business Name): NICK GEORGE KOINOGLOU D.C., FIAMA, DIPL AC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/02/2006
Last Update Date: 01/29/2024
Certification Date: 01/29/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2565 S UNION AVE
ALLIANCE OH
44601-5058
US

IV. Provider business mailing address

2565 S UNION AVE
ALLIANCE OH
44601-5058
US

V. Phone/Fax

Practice location:
  • Phone: 330-821-4455
  • Fax: 330-821-4504
Mailing address:
  • Phone: 330-821-4455
  • Fax: 330-821-4504

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number1798
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: