Provider Demographics
NPI:1417915596
Name:NICHOLS, CHRISTOPHER TODD (MD)
Entity Type:Individual
Prefix:DR
First Name:CHRISTOPHER
Middle Name:TODD
Last Name:NICHOLS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4012 BARBE WOOD DR
Mailing Address - Street 2:
Mailing Address - City:LAKE CHARLES
Mailing Address - State:LA
Mailing Address - Zip Code:70605-2316
Mailing Address - Country:US
Mailing Address - Phone:251-377-5228
Mailing Address - Fax:818-671-2225
Practice Address - Street 1:8088 HAWKS RD
Practice Address - Street 2:
Practice Address - City:LEESVILLE
Practice Address - State:LA
Practice Address - Zip Code:71446-6649
Practice Address - Country:US
Practice Address - Phone:251-377-5228
Practice Address - Fax:818-671-2225
Is Sole Proprietor?:No
Enumeration Date:2006-05-01
Last Update Date:2024-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL00023044208100000X
LA311032208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1417915596OtherBCBS
LA1417915596OtherAETNA
LA1485250Medicaid
631187140OtherTAX ID
MS00125715Medicaid
H09628Medicare UPIN
MS00125715Medicaid