MEDICARE: NICHOLAS KATRIS DACM, LAC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	171100000X	Acupuncturist	9210673-1201	UT

General Provider Information

NPI Number	:	1235011800
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NICHOLAS KATRIS DACM, LAC.

Provider Business Mailing Address
First Line	:	4455 S 700 E STE 201
Second Line	:
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84107-3076
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	4455 S 700 E STE 201
Second Line	:
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84107-3076
Country	:	US
Telephone Number	:	801-699-5960
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/23/2025
Last Update Date	:	07/23/2025

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