Provider Demographics
NPI:1851572010
Name:NICHOLSON, PATRICK J (DC)
Entity Type:Individual
Prefix:
First Name:PATRICK
Middle Name:J
Last Name:NICHOLSON
Suffix:
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 1:16 CANALVIEW MALL
Mailing Address - Street 2:
Mailing Address - City:FULTON
Mailing Address - State:NY
Mailing Address - Zip Code:13069-1733
Mailing Address - Country:US
Mailing Address - Phone:315-592-4740
Mailing Address - Fax:
Practice Address - Street 1:16 CANALVIEW MALL
Practice Address - Street 2:
Practice Address - City:FULTON
Practice Address - State:NY
Practice Address - Zip Code:13069-1733
Practice Address - Country:US
Practice Address - Phone:315-592-4740
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-16
Last Update Date:2008-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX008569NY111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYRA5347Medicare PIN