Provider Demographics
NPI:1720055718
Name:NICHOLS, JARROD LESLIE (DC)
Entity Type:Individual
Prefix:DR
First Name:JARROD
Middle Name:LESLIE
Last Name:NICHOLS
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 1:709 COMMONS PL
Mailing Address - Street 2:
Mailing Address - City:MANHATTAN
Mailing Address - State:KS
Mailing Address - Zip Code:66503-3002
Mailing Address - Country:US
Mailing Address - Phone:785-537-2211
Mailing Address - Fax:785-537-2211
Practice Address - Street 1:709 COMMONS PL
Practice Address - Street 2:
Practice Address - City:MANHATTAN
Practice Address - State:KS
Practice Address - Zip Code:66503-3002
Practice Address - Country:US
Practice Address - Phone:785-537-2211
Practice Address - Fax:785-537-2211
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS01-04939111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS62209Medicare ID - Type UnspecifiedINDIVIDUAL PROVIDER #