Provider Demographics
NPI:1518114792
Name:JAIN, NITIN
Entity Type:Individual
Prefix:
First Name:NITIN
Middle Name:
Last Name:JAIN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1201 E MICHIGAN AVE STE 320
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:MI
Mailing Address - Zip Code:49201-1854
Mailing Address - Country:US
Mailing Address - Phone:517-205-7633
Mailing Address - Fax:
Practice Address - Street 1:1201 E MICHIGAN AVE STE 320
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:MI
Practice Address - Zip Code:49201-1854
Practice Address - Country:US
Practice Address - Phone:517-205-7633
Practice Address - Fax:517-817-7634
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-19
Last Update Date:2021-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501013724225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist