Provider Demographics
NPI:1417354325
Name:NICHOLS, MILES (LAC)
Entity Type:Individual
Prefix:
First Name:MILES
Middle Name:
Last Name:NICHOLS
Suffix:
Gender:M
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 221
Mailing Address - Street 2:
Mailing Address - City:JAMESTOWN
Mailing Address - State:CO
Mailing Address - Zip Code:80455-0221
Mailing Address - Country:US
Mailing Address - Phone:720-722-1143
Mailing Address - Fax:
Practice Address - Street 1:2035 E ARAPAHOE RD
Practice Address - Street 2:SUITE #123
Practice Address - City:CENTENNIAL
Practice Address - State:CO
Practice Address - Zip Code:80122-1505
Practice Address - Country:US
Practice Address - Phone:720-722-1143
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-11-21
Last Update Date:2014-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO2038171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist