Provider Demographics
NPI:1578870432
Name:KIRK, NICKY MATHEW (DC)
Entity type:Individual
Prefix:
First Name:NICKY
Middle Name:MATHEW
Last Name:KIRK
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 1:1612 MACK LN
Mailing Address - Street 2:
Mailing Address - City:LITTLE ELM
Mailing Address - State:TX
Mailing Address - Zip Code:75068-1996
Mailing Address - Country:US
Mailing Address - Phone:972-679-7894
Mailing Address - Fax:
Practice Address - Street 1:3800 GAYLORD PKWY STE 795
Practice Address - Street 2:
Practice Address - City:FRISCO
Practice Address - State:TX
Practice Address - Zip Code:75034-1102
Practice Address - Country:US
Practice Address - Phone:214-902-3400
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-13
Last Update Date:2024-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX14039111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor