Provider Demographics
NPI:1942357728
Name:HOUSTON, NICHOLAS BRANDON (DC)
Entity Type:Individual
Prefix:
First Name:NICHOLAS
Middle Name:BRANDON
Last Name:HOUSTON
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 1:16101 VENTURA BLVD STE 330
Mailing Address - Street 2:
Mailing Address - City:ENCINO
Mailing Address - State:CA
Mailing Address - Zip Code:91436-2516
Mailing Address - Country:US
Mailing Address - Phone:818-788-2884
Mailing Address - Fax:818-788-0507
Practice Address - Street 1:16101 VENTURA BLVD STE 330
Practice Address - Street 2:
Practice Address - City:ENCINO
Practice Address - State:CA
Practice Address - Zip Code:91436-2516
Practice Address - Country:US
Practice Address - Phone:818-788-2884
Practice Address - Fax:818-788-0507
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-04
Last Update Date:2011-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA16415111NX0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NX0800XChiropractic ProvidersChiropractorOrthopedic
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADC16415Medicare UPIN