Provider Demographics
NPI:1558727701
Name:NICHOLS CHIROPRACTIC, LLC
Entity Type:Organization
Organization Name:NICHOLS CHIROPRACTIC, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:KASEY
Authorized Official - Middle Name:MICHELLE
Authorized Official - Last Name:NICHOLS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:918-637-3630
Mailing Address - Street 1:200 N MISSION ST
Mailing Address - Street 2:
Mailing Address - City:SAPULPA
Mailing Address - State:OK
Mailing Address - Zip Code:74066-3600
Mailing Address - Country:US
Mailing Address - Phone:918-637-3630
Mailing Address - Fax:
Practice Address - Street 1:200 N MISSION ST
Practice Address - Street 2:
Practice Address - City:SAPULPA
Practice Address - State:OK
Practice Address - Zip Code:74066-3600
Practice Address - Country:US
Practice Address - Phone:918-637-3630
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-01-04
Last Update Date:2016-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK3981111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty