Provider Demographics
NPI:1437334364
Name:NICHOLSON, LORI LAMITINA (DC)
Entity Type:Individual
Prefix:
First Name:LORI
Middle Name:LAMITINA
Last Name:NICHOLSON
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:LORI
Other - Middle Name:ANN
Other - Last Name:LAMITINA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DC
Mailing Address - Street 1:PO BOX 250225
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72225
Mailing Address - Country:US
Mailing Address - Phone:501-664-6664
Mailing Address - Fax:501-664-6614
Practice Address - Street 1:1405 NORTH PIERCE STREET
Practice Address - Street 2:SUITE 210
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72207
Practice Address - Country:US
Practice Address - Phone:501-664-6664
Practice Address - Fax:501-664-6614
Is Sole Proprietor?:No
Enumeration Date:2008-01-09
Last Update Date:2010-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR1550111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor