Provider Demographics
NPI:1871836080
Name:NICHOLL CHIROPRACTIC, INC.
Entity Type:Organization
Organization Name:NICHOLL CHIROPRACTIC, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER / PROVIDER
Authorized Official - Prefix:DR
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:L
Authorized Official - Last Name:NICHOLL
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:916-594-7630
Mailing Address - Street 1:2210 LAKE WASHINGTON BLVD STE 130
Mailing Address - Street 2:
Mailing Address - City:WEST SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95691-6425
Mailing Address - Country:US
Mailing Address - Phone:916-594-7630
Mailing Address - Fax:
Practice Address - Street 1:2210 LAKE WASHINGTON BLVD STE 130
Practice Address - Street 2:
Practice Address - City:WEST SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95691-6425
Practice Address - Country:US
Practice Address - Phone:916-594-7630
Practice Address - Fax:916-538-6771
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-04-05
Last Update Date:2019-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC32059111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty