Healthcare Provider Details

I. General information

NPI: 1912813304
Provider Name (Legal Business Name): NICHOLAS DEONTE HILSON
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/24/2026
Last Update Date: 08/24/2026
Certification Date: 08/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3615 S HOUSTON LEVEE RD STE 110
COLLIERVILLE TN
38017-9173
US

IV. Provider business mailing address

3615 S HOUSTON LEVEE RD STE 110
COLLIERVILLE TN
38017-9173
US

V. Phone/Fax

Practice location:
  • Phone: 901-221-7173
  • Fax: 901-221-7934
Mailing address:
  • Phone: 901-221-7173
  • Fax: 901-221-7934

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number1410
License Number StateMS
# 2
Primary TaxonomyN
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number3670
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: