Provider Demographics
NPI:1548405632
Name:NICHOLSON, KATRINA RUTH (DC)
Entity Type:Individual
Prefix:DR
First Name:KATRINA
Middle Name:RUTH
Last Name:NICHOLSON
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:KATRINA
Other - Middle Name:RUTH
Other - Last Name:BOSWELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DC
Mailing Address - Street 1:500 PERRY RD STE 202
Mailing Address - Street 2:
Mailing Address - City:GRAND BLANC
Mailing Address - State:MI
Mailing Address - Zip Code:48439-1421
Mailing Address - Country:US
Mailing Address - Phone:810-771-7624
Mailing Address - Fax:
Practice Address - Street 1:500 PERRY RD STE 202
Practice Address - Street 2:
Practice Address - City:GRAND BLANC
Practice Address - State:MI
Practice Address - Zip Code:48439-1421
Practice Address - Country:US
Practice Address - Phone:810-771-7624
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-12-03
Last Update Date:2016-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038011292111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor