Provider Demographics
NPI:1811527005
Name:NICKERSON, MATTHEW E (DC)
Entity type:Individual
Prefix:DR
First Name:MATTHEW
Middle Name:E
Last Name:NICKERSON
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 1:711 ALBERT PIKE RD
Mailing Address - Street 2:
Mailing Address - City:HOT SPRINGS
Mailing Address - State:AR
Mailing Address - Zip Code:71913-4143
Mailing Address - Country:US
Mailing Address - Phone:501-321-2225
Mailing Address - Fax:501-623-1255
Practice Address - Street 1:711 ALBERT PIKE RD
Practice Address - Street 2:
Practice Address - City:HOT SPRINGS
Practice Address - State:AR
Practice Address - Zip Code:71913-4143
Practice Address - Country:US
Practice Address - Phone:501-321-2225
Practice Address - Fax:501-623-1255
Is Sole Proprietor?:No
Enumeration Date:2020-01-16
Last Update Date:2020-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR16248111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor