Provider Demographics
NPI:1205166840
Name:NICHOLSON, EGERTON ROY (DC)
Entity type:Individual
Prefix:DR
First Name:EGERTON
Middle Name:ROY
Last Name:NICHOLSON
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 1:288 MARTIN ST
Mailing Address - Street 2:105
Mailing Address - City:BLAINE
Mailing Address - State:WA
Mailing Address - Zip Code:98230-4045
Mailing Address - Country:US
Mailing Address - Phone:360-603-4120
Mailing Address - Fax:
Practice Address - Street 1:288 MARTIN ST
Practice Address - Street 2:105
Practice Address - City:BLAINE
Practice Address - State:WA
Practice Address - Zip Code:98230-4045
Practice Address - Country:US
Practice Address - Phone:360-603-4120
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-01-04
Last Update Date:2010-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACH60112736111NR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NR0400XChiropractic ProvidersChiropractorRehabilitation