Individual
DR. IAN ANTHONY NICOLAIDES
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.C.
Contact information
Practice address
601 W MAIN ST, CARBONDALE, IL 62901-2603
(618) 529-5450
(618) 549-4354
Mailing address
601 W MAIN ST, CARBONDALE, IL 62901-2603
(618) 529-5450
(618) 549-4354
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
Primary
—
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
039-22545
BLUECROSS BLUESHIELD IL
IL
01
—
397403
HEALTHLINK
IL
Enumeration date
01/02/2007
Last updated
07/08/2007
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