Provider Demographics
NPI:1740409879
Name:JON R. NICHOLS CHIROPRACTIC, INC.
Entity Type:Organization
Organization Name:JON R. NICHOLS CHIROPRACTIC, INC.
Other - Org Name:ALLIANCE FAMILY CHIROPRACTIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JON
Authorized Official - Middle Name:ROSS
Authorized Official - Last Name:NICHOLS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:408-945-1233
Mailing Address - Street 1:545 LOS COCHES ST
Mailing Address - Street 2:SUITE 104
Mailing Address - City:MILPITAS
Mailing Address - State:CA
Mailing Address - Zip Code:95035-5483
Mailing Address - Country:US
Mailing Address - Phone:408-945-1233
Mailing Address - Fax:408-956-8812
Practice Address - Street 1:545 LOS COCHES ST
Practice Address - Street 2:SUITE 104
Practice Address - City:MILPITAS
Practice Address - State:CA
Practice Address - Zip Code:95035-5483
Practice Address - Country:US
Practice Address - Phone:408-945-1233
Practice Address - Fax:408-956-8812
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-25
Last Update Date:2011-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC25361111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CACG168BMedicare PIN
CADC25361Medicare ID - Type Unspecified