Provider Demographics
NPI:1437774999
Name:BRAUTIGAM, NICHOLAS ALAN (BS, DC)
Entity Type:Individual
Prefix:DR
First Name:NICHOLAS
Middle Name:ALAN
Last Name:BRAUTIGAM
Suffix:
Gender:M
Credentials:BS, DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1200 SOMERBY DR
Mailing Address - Street 2:APT 1035 MAILBOX#160
Mailing Address - City:MOBILE
Mailing Address - State:AL
Mailing Address - Zip Code:36695
Mailing Address - Country:US
Mailing Address - Phone:770-841-0317
Mailing Address - Fax:
Practice Address - Street 1:960 SCHILLINGER RD S
Practice Address - Street 2:SUITE D
Practice Address - City:MOBILE
Practice Address - State:AL
Practice Address - Zip Code:36695
Practice Address - Country:US
Practice Address - Phone:251-525-9512
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-06-10
Last Update Date:2020-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL2646111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor