Provider Demographics
NPI:1003625567
Name:WRIGHT, NOLAN JAMES (DC)
Entity type:Individual
Prefix:DR
First Name:NOLAN
Middle Name:JAMES
Last Name:WRIGHT
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 1:4965 STONE FALLS CTR STE 7
Mailing Address - Street 2:
Mailing Address - City:O FALLON
Mailing Address - State:IL
Mailing Address - Zip Code:62269-7803
Mailing Address - Country:US
Mailing Address - Phone:618-622-9780
Mailing Address - Fax:
Practice Address - Street 1:4965 STONE FALLS CTR STE 7
Practice Address - Street 2:
Practice Address - City:O FALLON
Practice Address - State:IL
Practice Address - Zip Code:62269-7803
Practice Address - Country:US
Practice Address - Phone:618-622-9780
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-12-30
Last Update Date:2024-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038014233111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor