Provider Demographics
NPI:1396999843
Name:NICHOLS, CANDIE L (LMT)
Entity type:Individual
Prefix:
First Name:CANDIE
Middle Name:L
Last Name:NICHOLS
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1710 COVEMEADOW CT
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:TX
Mailing Address - Zip Code:76012-5406
Mailing Address - Country:US
Mailing Address - Phone:817-437-4511
Mailing Address - Fax:
Practice Address - Street 1:1710 COVEMEADOW CT
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76012-5406
Practice Address - Country:US
Practice Address - Phone:817-437-4511
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-11
Last Update Date:2008-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXLMT027176173C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes173C00000XOther Service ProvidersReflexologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX027176OtherLMT 027176