Provider Demographics
NPI:1508930942
Name:CLINE, NICHOLAS DAVID (DC)
Entity Type:Individual
Prefix:DR
First Name:NICHOLAS
Middle Name:DAVID
Last Name:CLINE
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5010 GRANGE RD
Mailing Address - Street 2:SUITE 103
Mailing Address - City:ROSEBURG
Mailing Address - State:OR
Mailing Address - Zip Code:97470-5846
Mailing Address - Country:US
Mailing Address - Phone:541-679-0741
Mailing Address - Fax:541-679-0751
Practice Address - Street 1:5010 GRANGE RD
Practice Address - Street 2:SUITE 103
Practice Address - City:ROSEBURG
Practice Address - State:OR
Practice Address - Zip Code:97470-5846
Practice Address - Country:US
Practice Address - Phone:541-679-0741
Practice Address - Fax:541-679-0751
Is Sole Proprietor?:No
Enumeration Date:2006-11-18
Last Update Date:2008-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR27 3494111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
ORU99166Medicare UPIN
OR131889Medicare PIN