Provider Demographics
NPI:1568412757
Name:NICHOLS, LORRI A (DC)
Entity Type:Individual
Prefix:
First Name:LORRI
Middle Name:A
Last Name:NICHOLS
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:LORRI
Other - Middle Name:
Other - Last Name:O'HOLLAREN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DC
Mailing Address - Street 1:34730 PACIFIC HWY S
Mailing Address - Street 2:
Mailing Address - City:FEDERAL WAY
Mailing Address - State:WA
Mailing Address - Zip Code:98003-6821
Mailing Address - Country:US
Mailing Address - Phone:253-927-0660
Mailing Address - Fax:
Practice Address - Street 1:34730 PACIFIC HWY S
Practice Address - Street 2:
Practice Address - City:FEDERAL WAY
Practice Address - State:WA
Practice Address - Zip Code:98003-6821
Practice Address - Country:US
Practice Address - Phone:253-927-0660
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-11
Last Update Date:2009-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACH00001902111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAOH6332OtherREGENCE BLUE SHIELD
WA0065641OtherLABOR AND INDUSTRIES
WA0065641OtherLABOR AND INDUSTRIES
WAU21207Medicare UPIN