Provider Demographics
NPI:1528537149
Name:JOLLEY, NICHOLAS H (DC)
Entity Type:Individual
Prefix:DR
First Name:NICHOLAS
Middle Name:H
Last Name:JOLLEY
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 1:2204 SANDALWOOD DR
Mailing Address - Street 2:
Mailing Address - City:FERN PARK
Mailing Address - State:FL
Mailing Address - Zip Code:32730-2236
Mailing Address - Country:US
Mailing Address - Phone:814-558-2125
Mailing Address - Fax:
Practice Address - Street 1:11500 UNIVERSITY BLVD STE 103
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32817-2155
Practice Address - Country:US
Practice Address - Phone:407-658-6500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-11-14
Last Update Date:2018-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL12647111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor