Provider Demographics
NPI:1841298940
Name:NICHOLSON, DEAN (DC)
Entity type:Individual
Prefix:
First Name:DEAN
Middle Name:
Last Name:NICHOLSON
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 1:4411 STILLEY RD
Mailing Address - Street 2:
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15227-1368
Mailing Address - Country:US
Mailing Address - Phone:412-440-0490
Mailing Address - Fax:412-440-0493
Practice Address - Street 1:4411 STILLEY RD
Practice Address - Street 2:
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15227-1368
Practice Address - Country:US
Practice Address - Phone:412-440-0490
Practice Address - Fax:412-440-0493
Is Sole Proprietor?:No
Enumeration Date:2005-07-12
Last Update Date:2011-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA7833L111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA00019444200001Medicaid
PAU84971Medicare UPIN
PA47565Medicare ID - Type Unspecified