MEDICARE: DR. PLACIDO NICDAO II D.C.

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	111N00000X	Chiropractor	CHIR008840	GA
2	111N00000X	Chiropractor	C37	GU

General Provider Information

NPI Number	:	1851672539
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. PLACIDO NICDAO II D.C.

Provider Business Mailing Address
First Line	:	643 CHALAN SAN ANTONIO
Second Line	:	STE 101
City	:	TAMUNING
State	:	GU
Zip	:	96913-3644
Country	:	US
Telephone Number	:	671-472-2225
Fax Number	:	671-472-4476

Provider Business Practice Location Address
First Line	:	643 CHALAN SAN ANTONIO
Second Line	:	STE 101
City	:	TAMUNING
State	:	GU
Zip	:	96913-3644
Country	:	US
Telephone Number	:	671-472-2225
Fax Number	:	671-472-4476

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

Provider Enumeration Date	:	09/08/2011
Last Update Date	:	01/05/2016

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