MEDICARE: MR. NICHOLAS MARK TANCHEFF 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	1216	HI
2	111N00000X	Chiropractor	DC-1216	HI

General Provider Information

NPI Number	:	1992093769
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. NICHOLAS MARK TANCHEFF D.C.

Provider Business Mailing Address
First Line	:	68-1749 HOOHIKI PL
Second Line	:
City	:	WAIKOLOA
State	:	HI
Zip	:	96738-5105
Country	:	US
Telephone Number	:	808-209-8002
Fax Number	:	440-212-7006

Provider Business Practice Location Address
First Line	:	68-1820 WAIKOLOA RD STE 501
Second Line	:
City	:	WAIKOLOA
State	:	HI
Zip	:	96738-5597
Country	:	US
Telephone Number	:	808-209-8002
Fax Number	:	440-212-7006

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

Provider Enumeration Date	:	07/14/2011
Last Update Date	:	01/24/2025

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