MEDICARE: NINA PRIDHAM D.C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor	5568	OR
2	111N00000X	Chiropractor	772	WY

General Provider Information

NPI Number	:	1568868453
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NINA PRIDHAM D.C

Provider Business Mailing Address
First Line	:	3075 W HOMA HILLS RD
Second Line	:
City	:	CASPER
State	:	WY
Zip	:	82601-7438
Country	:	US
Telephone Number	:	503-703-6120
Fax Number	:

Provider Business Practice Location Address
First Line	:	3075 W HOMA HILLS RD
Second Line	:
City	:	CASPER
State	:	WY
Zip	:	82601
Country	:	US
Telephone Number	:	503-703-6120
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/05/2014
Last Update Date	:	05/27/2018

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Directions to “ NINA PRIDHAM D.C” Practice Location

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