Provider Demographics
NPI:1184624793
Name:NICKELL, MERLE DEAN (DC)
Entity type:Individual
Prefix:DR
First Name:MERLE
Middle Name:DEAN
Last Name:NICKELL
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 1:359 N OLD US HIGHWAY 81
Mailing Address - Street 2:PO BOX 246
Mailing Address - City:HESSTON
Mailing Address - State:KS
Mailing Address - Zip Code:67062-9406
Mailing Address - Country:US
Mailing Address - Phone:620-327-2244
Mailing Address - Fax:620-327-5157
Practice Address - Street 1:359 N OLD US HIGHWAY 81
Practice Address - Street 2:
Practice Address - City:HESSTON
Practice Address - State:KS
Practice Address - Zip Code:67062-9406
Practice Address - Country:US
Practice Address - Phone:620-327-2244
Practice Address - Fax:620-327-5157
Is Sole Proprietor?:No
Enumeration Date:2005-07-26
Last Update Date:2020-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KSC3589111N00000X
KS01-03589111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
T43806Medicare UPIN
KS062397Medicare Oscar/Certification