Provider Demographics
NPI:1619066800
Name:CROM, NICHLOS JASON (DC)
Entity Type:Individual
Prefix:DR
First Name:NICHLOS
Middle Name:JASON
Last Name:CROM
Suffix:
Gender:M
Credentials:DC
Other - Prefix:DR
Other - First Name:NICK
Other - Middle Name:JASON
Other - Last Name:CROM
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DC
Mailing Address - Street 1:17931 PIERCE PLZ
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68130-2654
Mailing Address - Country:US
Mailing Address - Phone:402-502-6888
Mailing Address - Fax:
Practice Address - Street 1:17931 PIERCE PLZ
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68130-2654
Practice Address - Country:US
Practice Address - Phone:402-502-6888
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-12
Last Update Date:2017-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE1396111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE10025288300Medicaid
NE10025288300Medicaid