Provider Demographics
NPI:1568879708
Name:WEST, NICHOLAS (DC)
Entity Type:Individual
Prefix:
First Name:NICHOLAS
Middle Name:
Last Name:WEST
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 1:4 TOUCHSTONE #64
Mailing Address - Street 2:
Mailing Address - City:LAKE OSWEGO
Mailing Address - State:OR
Mailing Address - Zip Code:97035
Mailing Address - Country:US
Mailing Address - Phone:971-777-0238
Mailing Address - Fax:
Practice Address - Street 1:30485 SW BOONES FERRY RD
Practice Address - Street 2:SUITE 104
Practice Address - City:WILSONVILLE
Practice Address - State:OR
Practice Address - Zip Code:97070-7845
Practice Address - Country:US
Practice Address - Phone:971-777-0238
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-07-21
Last Update Date:2014-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR5573111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor