Provider Demographics
NPI:1073056289
Name:GRABLE, NICHOLAS (DC)
Entity Type:Individual
Prefix:DR
First Name:NICHOLAS
Middle Name:
Last Name:GRABLE
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 1:842 E WINDING CREEK DR
Mailing Address - Street 2:
Mailing Address - City:EAGLE
Mailing Address - State:ID
Mailing Address - Zip Code:83616-7214
Mailing Address - Country:US
Mailing Address - Phone:208-481-4705
Mailing Address - Fax:208-906-1025
Practice Address - Street 1:600 E STATE ST STE 100
Practice Address - Street 2:
Practice Address - City:EAGLE
Practice Address - State:ID
Practice Address - Zip Code:83616-6082
Practice Address - Country:US
Practice Address - Phone:208-939-6748
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-11-21
Last Update Date:2021-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDCHIA-1766111NN1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NN1001XChiropractic ProvidersChiropractorNutrition