Provider Demographics
NPI:1376559062
Name:NOLEN, JOHN ALAN (DC)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:ALAN
Last Name:NOLEN
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1000 FACTORY OUTLET BLVD
Mailing Address - Street 2:STE 111
Mailing Address - City:WEST FRANKFORT
Mailing Address - State:IL
Mailing Address - Zip Code:62896-4179
Mailing Address - Country:US
Mailing Address - Phone:618-937-4164
Mailing Address - Fax:618-932-3203
Practice Address - Street 1:107 S VAN BUREN ST
Practice Address - Street 2:
Practice Address - City:WEST FRANKFORT
Practice Address - State:IL
Practice Address - Zip Code:62896-2907
Practice Address - Country:US
Practice Address - Phone:618-937-4164
Practice Address - Fax:618-932-3203
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-01
Last Update Date:2020-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL38003613111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILT35489Medicare UPIN
IL236520Medicare ID - Type Unspecified