Provider Demographics
NPI:1851468219
Name:COLES, NATHAN LEWIS SR (DC)
Entity Type:Individual
Prefix:DR
First Name:NATHAN
Middle Name:LEWIS
Last Name:COLES
Suffix:SR
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 1:107 DURWOOD CT
Mailing Address - Street 2:
Mailing Address - City:NEW BERN
Mailing Address - State:NC
Mailing Address - Zip Code:28562-2274
Mailing Address - Country:US
Mailing Address - Phone:252-571-1573
Mailing Address - Fax:
Practice Address - Street 1:107 DURWOOD CT
Practice Address - Street 2:
Practice Address - City:NEW BERN
Practice Address - State:NC
Practice Address - Zip Code:28562-2274
Practice Address - Country:US
Practice Address - Phone:252-571-1573
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-29
Last Update Date:2014-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC3660111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC0856GOtherBCBS
NC5914314Medicaid
NC5914314Medicaid