Provider Demographics
NPI:1629245451
Name:NICHOLS CHIROPRACTIC, PLC
Entity Type:Organization
Organization Name:NICHOLS CHIROPRACTIC, PLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:DAVID
Authorized Official - Last Name:NICHOLS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:319-987-3080
Mailing Address - Street 1:308 MAIN ST
Mailing Address - Street 2:PO BOX 130
Mailing Address - City:JANESVILLE
Mailing Address - State:IA
Mailing Address - Zip Code:50647-7785
Mailing Address - Country:US
Mailing Address - Phone:319-987-3080
Mailing Address - Fax:319-987-3080
Practice Address - Street 1:308 MAIN ST
Practice Address - Street 2:
Practice Address - City:JANESVILLE
Practice Address - State:IA
Practice Address - Zip Code:50647-7785
Practice Address - Country:US
Practice Address - Phone:319-987-3080
Practice Address - Fax:319-987-3080
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-12
Last Update Date:2008-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA06453111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA04192OtherWELLMARK BLUE CROSS BLUE SHIELD
IA2264465Medicaid
IA2264465Medicaid
IAI16594Medicare PIN
IAI16595Medicare PIN