Provider Demographics
NPI:1548492853
Name:BELVILLE, NICHOLAS MORRIS (DC)
Entity type:Individual
Prefix:
First Name:NICHOLAS
Middle Name:MORRIS
Last Name:BELVILLE
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 1:440 N KOELLER ST
Mailing Address - Street 2:
Mailing Address - City:OSHKOSH
Mailing Address - State:WI
Mailing Address - Zip Code:54902-4111
Mailing Address - Country:US
Mailing Address - Phone:920-233-2828
Mailing Address - Fax:920-232-2829
Practice Address - Street 1:440 N KOELLER ST
Practice Address - Street 2:
Practice Address - City:OSHKOSH
Practice Address - State:WI
Practice Address - Zip Code:54902-4111
Practice Address - Country:US
Practice Address - Phone:920-233-2828
Practice Address - Fax:920-232-2829
Is Sole Proprietor?:No
Enumeration Date:2009-08-20
Last Update Date:2009-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI4532012111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor