Provider Demographics
NPI:1033110804
Name:NICHOLS, LAWRENCE S III (DC)
Entity Type:Individual
Prefix:DR
First Name:LAWRENCE
Middle Name:S
Last Name:NICHOLS
Suffix:III
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 1:2696 HWY 77 S
Mailing Address - Street 2:
Mailing Address - City:MARION
Mailing Address - State:AR
Mailing Address - Zip Code:72364-2373
Mailing Address - Country:US
Mailing Address - Phone:870-739-2500
Mailing Address - Fax:870-739-4979
Practice Address - Street 1:2696 HWY 77 S
Practice Address - Street 2:
Practice Address - City:MARION
Practice Address - State:AR
Practice Address - Zip Code:72364-2373
Practice Address - Country:US
Practice Address - Phone:870-739-2500
Practice Address - Fax:870-739-4979
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-03
Last Update Date:2010-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR1297111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
ARU32699Medicare UPIN
AR13783025Medicare ID - Type Unspecified