Provider Demographics
NPI:1043495799
Name:NYGREN, JACQULYN L (DC)
Entity Type:Individual
Prefix:DR
First Name:JACQULYN
Middle Name:L
Last Name:NYGREN
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:120 LOWES DR
Mailing Address - Street 2:SUITE 105
Mailing Address - City:PITTSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27312-8306
Mailing Address - Country:US
Mailing Address - Phone:919-642-0555
Mailing Address - Fax:919-642-0556
Practice Address - Street 1:120 LOWES DR
Practice Address - Street 2:STE 105
Practice Address - City:PITTSBORO
Practice Address - State:NC
Practice Address - Zip Code:27312-8306
Practice Address - Country:US
Practice Address - Phone:919-642-0555
Practice Address - Fax:919-642-0556
Is Sole Proprietor?:No
Enumeration Date:2007-12-31
Last Update Date:2008-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC3694111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor