Provider Demographics
NPI:1881011476
Name:NICHOLSON, TYLER (D,C)
Entity Type:Individual
Prefix:DR
First Name:TYLER
Middle Name:
Last Name:NICHOLSON
Suffix:
Gender:M
Credentials:D,C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 187
Mailing Address - Street 2:
Mailing Address - City:LEISENRING
Mailing Address - State:PA
Mailing Address - Zip Code:15455-0187
Mailing Address - Country:US
Mailing Address - Phone:724-603-3233
Mailing Address - Fax:724-603-3235
Practice Address - Street 1:110 S ARCH ST
Practice Address - Street 2:STE 1A
Practice Address - City:CONNELLSVILLE
Practice Address - State:PA
Practice Address - Zip Code:15425-3515
Practice Address - Country:US
Practice Address - Phone:724-603-3233
Practice Address - Fax:724-603-3235
Is Sole Proprietor?:Yes
Enumeration Date:2014-03-21
Last Update Date:2016-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC010841111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor