Provider Demographics
NPI:1548635642
Name:KIZZIRE, NICHOLAS MICHAEL JAMES (DC)
Entity type:Individual
Prefix:
First Name:NICHOLAS
Middle Name:MICHAEL JAMES
Last Name:KIZZIRE
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 1:327 W 11TH ST
Mailing Address - Street 2:
Mailing Address - City:BAYARD
Mailing Address - State:NE
Mailing Address - Zip Code:69334-2017
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:221 BOX BUTTE AVE
Practice Address - Street 2:
Practice Address - City:ALLIANCE
Practice Address - State:NE
Practice Address - Zip Code:69301-3741
Practice Address - Country:US
Practice Address - Phone:308-761-1145
Practice Address - Fax:308-761-1143
Is Sole Proprietor?:Yes
Enumeration Date:2015-12-01
Last Update Date:2015-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE1871111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor