Provider Demographics
NPI:1013965813
Name:NICHOLS, BRIAN E (MS ATC)
Entity Type:Individual
Prefix:MR
First Name:BRIAN
Middle Name:E
Last Name:NICHOLS
Suffix:
Gender:M
Credentials:MS ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:749 VILLAGE DR
Mailing Address - Street 2:
Mailing Address - City:FOWLERVILLE
Mailing Address - State:MI
Mailing Address - Zip Code:48836-7930
Mailing Address - Country:US
Mailing Address - Phone:517-223-1070
Mailing Address - Fax:
Practice Address - Street 1:2300 GENOA BUSINESS PARK DR
Practice Address - Street 2:SUITE 120
Practice Address - City:BRIGHTON
Practice Address - State:MI
Practice Address - Zip Code:48114-7367
Practice Address - Country:US
Practice Address - Phone:810-299-8557
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer