Healthcare Provider Details

I. General information

NPI: 1841778677
Provider Name (Legal Business Name): NICHOLAS GENE TAGLIAFERRO DC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/03/2018
Last Update Date: 08/03/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1301 W LANE AVE
COLUMBUS OH
43221-3514
US

IV. Provider business mailing address

1301 W LANE AVE
COLUMBUS OH
43221-3514
US

V. Phone/Fax

Practice location:
  • Phone: 614-486-3950
  • Fax: 614-486-3960
Mailing address:
  • Phone: 614-486-3950
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NR0400X
TaxonomyRehabilitation Chiropractor
License NumberDC-04779
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: