Provider Demographics
NPI:1740328509
Name:NICHOLS, MICHAEL D (DC)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:D
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 1:199 N COMMON ST
Mailing Address - Street 2:
Mailing Address - City:LYNN
Mailing Address - State:MA
Mailing Address - Zip Code:01905-2516
Mailing Address - Country:US
Mailing Address - Phone:781-592-0002
Mailing Address - Fax:
Practice Address - Street 1:199 N COMMON ST
Practice Address - Street 2:
Practice Address - City:LYNN
Practice Address - State:MA
Practice Address - Zip Code:01905-2516
Practice Address - Country:US
Practice Address - Phone:781-592-0002
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-02
Last Update Date:2011-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2474111N00000X
NH592-0200111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA4418078OtherCIGNA HEALTHCARE
MA351901OtherHARVARD PILGRAM
NHNICH351719OtherANTHEM BCBS
MA1601920Medicaid
MAY36873OtherBCBS
MAY45517Medicare ID - Type Unspecified
MA1601920Medicaid