Provider Demographics
NPI:1902881873
Name:NICELY, AARON GRAVES (DC)
Entity Type:Individual
Prefix:DR
First Name:AARON
Middle Name:GRAVES
Last Name:NICELY
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1110 CASTALIA ST
Mailing Address - Street 2:SUITE G
Mailing Address - City:BELLEVUE
Mailing Address - State:OH
Mailing Address - Zip Code:44811-1181
Mailing Address - Country:US
Mailing Address - Phone:419-484-9070
Mailing Address - Fax:419-484-9070
Practice Address - Street 1:1110 CASTALIA ST
Practice Address - Street 2:SUITE G
Practice Address - City:BELLEVUE
Practice Address - State:OH
Practice Address - Zip Code:44811-1181
Practice Address - Country:US
Practice Address - Phone:419-484-9070
Practice Address - Fax:419-484-9070
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-13
Last Update Date:2009-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH3071111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2235192Medicaid
OH350051122OtherRAILROAD MEDICARE I.D. #
OH350051122OtherRAILROAD MEDICARE I.D. #
OHU82087Medicare UPIN