Provider Demographics
NPI:1861374308
Name:CRUZ, NIKOLAS (LMT)
Entity type:Individual
Prefix:
First Name:NIKOLAS
Middle Name:
Last Name:CRUZ
Suffix:
Gender:M
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:405 STURGIS ST
Mailing Address - Street 2:
Mailing Address - City:RAPID CITY
Mailing Address - State:SD
Mailing Address - Zip Code:57702-8135
Mailing Address - Country:US
Mailing Address - Phone:605-391-1678
Mailing Address - Fax:000-000-0000
Practice Address - Street 1:405 STURGIS ST
Practice Address - Street 2:
Practice Address - City:RAPID CITY
Practice Address - State:SD
Practice Address - Zip Code:57702-8135
Practice Address - Country:US
Practice Address - Phone:605-391-1678
Practice Address - Fax:000-000-0000
Is Sole Proprietor?:No
Enumeration Date:2025-07-24
Last Update Date:2025-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SDMT12173173C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes173C00000XOther Service ProvidersReflexologist