Provider Demographics
NPI:1518045087
Name:MORGAN-NICODEMUS, KAREN S (DC)
Entity Type:Individual
Prefix:DR
First Name:KAREN
Middle Name:S
Last Name:MORGAN-NICODEMUS
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:721 COURT ST
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:CA
Mailing Address - Zip Code:95642-2129
Mailing Address - Country:US
Mailing Address - Phone:209-273-7733
Mailing Address - Fax:
Practice Address - Street 1:721 COURT ST
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:CA
Practice Address - Zip Code:95642-2129
Practice Address - Country:US
Practice Address - Phone:209-273-7733
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-01
Last Update Date:2017-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC26781111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADC026781Medicare ID - Type UnspecifiedCHIROPRACTIC