Provider Demographics
NPI:1477632644
Name:NICOLA, JOHN A (DC)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:A
Last Name:NICOLA
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:JOHN
Other - Middle Name:A
Other - Last Name:NICOLA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:441 E CARSON ST
Mailing Address - Street 2:STE K
Mailing Address - City:CARSON
Mailing Address - State:CA
Mailing Address - Zip Code:90745-7713
Mailing Address - Country:US
Mailing Address - Phone:310-830-1766
Mailing Address - Fax:310-830-1786
Practice Address - Street 1:441 E CARSON ST
Practice Address - Street 2:STE K
Practice Address - City:CARSON
Practice Address - State:CA
Practice Address - Zip Code:90745-7713
Practice Address - Country:US
Practice Address - Phone:310-830-1766
Practice Address - Fax:310-830-1786
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-06
Last Update Date:2016-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC013627111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor