Provider Demographics
NPI:1750605226
Name:TRASTELIS, NICHOLAS JIM (DC)
Entity type:Individual
Prefix:DR
First Name:NICHOLAS
Middle Name:JIM
Last Name:TRASTELIS
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 1:850 CENTURY MEDICAL DR
Mailing Address - Street 2:
Mailing Address - City:TITUSVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32796-2141
Mailing Address - Country:US
Mailing Address - Phone:321-226-1115
Mailing Address - Fax:321-251-6091
Practice Address - Street 1:850 CENTURY MEDICAL DR
Practice Address - Street 2:
Practice Address - City:TITUSVILLE
Practice Address - State:FL
Practice Address - Zip Code:32796
Practice Address - Country:US
Practice Address - Phone:321-226-1115
Practice Address - Fax:321-251-6091
Is Sole Proprietor?:No
Enumeration Date:2010-03-26
Last Update Date:2018-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH9957111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor