Individual
NICHOLAS AUSTIN LIGHTFOOT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
532 N WALNUT ST, STE. B, BLOOMINGTON, IN 47404-3809
(812) 333-9404
(812) 333-2152
Mailing address
532 N WALNUT ST, STE. B, BLOOMINGTON, IN 47404-3809
(812) 333-9404
(812) 333-2152
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
Primary
08001909A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000079774
ANTHEM BLUE CROSS
IN
05
—
200270020A
—
IN
Enumeration date
05/02/2007
Last updated
07/08/2007
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