Provider Demographics
NPI:1396096582
Name:NICKELS, PAMELA LYN (DC)
Entity type:Individual
Prefix:DR
First Name:PAMELA
Middle Name:LYN
Last Name:NICKELS
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:PAMELA
Other - Middle Name:LYN
Other - Last Name:SKATES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1220 S CONGRESS BLVD
Mailing Address - Street 2:
Mailing Address - City:SMITHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37166-2035
Mailing Address - Country:US
Mailing Address - Phone:615-597-4445
Mailing Address - Fax:615-587-4477
Practice Address - Street 1:1220 S CONGRESS BLVD
Practice Address - Street 2:
Practice Address - City:SMITHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37166-2035
Practice Address - Country:US
Practice Address - Phone:615-597-4445
Practice Address - Fax:615-587-4477
Is Sole Proprietor?:No
Enumeration Date:2012-09-27
Last Update Date:2012-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNDC00000026111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor