Provider Demographics
NPI:1568092252
Name:PANNELLA, NICHOLAS JORDAN (DC)
Entity Type:Individual
Prefix:DR
First Name:NICHOLAS
Middle Name:JORDAN
Last Name:PANNELLA
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 1:4695 ARDLEY DR
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80922-2140
Mailing Address - Country:US
Mailing Address - Phone:719-358-9460
Mailing Address - Fax:
Practice Address - Street 1:4695 ARDLEY DR
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80922-2140
Practice Address - Country:US
Practice Address - Phone:719-358-9460
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-01-22
Last Update Date:2021-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COEL.2787092111N00000X
COCHR.0008166111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor