Provider Demographics
NPI:1457664682
Name:NICHOL, ALLISON (DO, ATC)
Entity Type:Individual
Prefix:
First Name:ALLISON
Middle Name:
Last Name:NICHOL
Suffix:
Gender:F
Credentials:DO, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2750 MAIN ST
Mailing Address - Street 2:SUITE 1
Mailing Address - City:MARLETTE
Mailing Address - State:MI
Mailing Address - Zip Code:48453-1100
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2750 MAIN ST
Practice Address - Street 2:SUITE 1
Practice Address - City:MARLETTE
Practice Address - State:MI
Practice Address - Zip Code:48453-1100
Practice Address - Country:US
Practice Address - Phone:989-635-4104
Practice Address - Fax:989-635-1877
Is Sole Proprietor?:No
Enumeration Date:2010-07-16
Last Update Date:2015-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI0804023942255A2300X
MI5101018973207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer