Provider Demographics
NPI:1659963890
Name:DORE, NICHOLAS M (PHD)
Entity Type:Individual
Prefix:DR
First Name:NICHOLAS
Middle Name:M
Last Name:DORE
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15 GABRIEL WAY
Mailing Address - Street 2:
Mailing Address - City:SULPHUR ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72579-9012
Mailing Address - Country:US
Mailing Address - Phone:870-656-8646
Mailing Address - Fax:
Practice Address - Street 1:15 GABRIEL WAY
Practice Address - Street 2:
Practice Address - City:SULPHUR ROCK
Practice Address - State:AR
Practice Address - Zip Code:72579-9012
Practice Address - Country:US
Practice Address - Phone:870-656-8646
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-02-09
Last Update Date:2021-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARL.AC.023171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist