Provider Demographics
NPI:1770264624
Name:NIKOLAY, MATTHEW T (DC)
Entity type:Individual
Prefix:DR
First Name:MATTHEW
Middle Name:T
Last Name:NIKOLAY
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 1:117 W UPHAM ST
Mailing Address - Street 2:
Mailing Address - City:MARSHFIELD
Mailing Address - State:WI
Mailing Address - Zip Code:54449-1458
Mailing Address - Country:US
Mailing Address - Phone:715-996-1000
Mailing Address - Fax:715-384-7910
Practice Address - Street 1:117 W UPHAM ST
Practice Address - Street 2:
Practice Address - City:MARSHFIELD
Practice Address - State:WI
Practice Address - Zip Code:54449-1458
Practice Address - Country:US
Practice Address - Phone:715-996-1000
Practice Address - Fax:715-384-7910
Is Sole Proprietor?:Yes
Enumeration Date:2023-07-25
Last Update Date:2023-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI6106-12111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor