Provider Demographics
NPI:1649602285
Name:PONOMARENKO, NICHOLAS (DC)
Entity type:Individual
Prefix:DR
First Name:NICHOLAS
Middle Name:
Last Name:PONOMARENKO
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 1:3121 CROSS TIMBERS RD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:FLOWER MOUND
Mailing Address - State:TX
Mailing Address - Zip Code:75028-2714
Mailing Address - Country:US
Mailing Address - Phone:972-539-2323
Mailing Address - Fax:
Practice Address - Street 1:3121 CROSS TIMBERS RD
Practice Address - Street 2:SUITE 100
Practice Address - City:FLOWER MOUND
Practice Address - State:TX
Practice Address - Zip Code:75028-2714
Practice Address - Country:US
Practice Address - Phone:972-539-2323
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-08-06
Last Update Date:2016-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX11984111N00000X, 111NS0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
No111NS0005XChiropractic ProvidersChiropractorSports Physician