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NPI Code Detail

MEDICARE: DEPAUL NICHOLS

MEDICARE: DEPAUL NICHOLS
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
1111N00000XChiropractor3499TN

General Provider Information

NPI Number : 1790442366
Entity Type Code : Individual
Provider Name (Legal Business Name) : DEPAUL NICHOLS
Provider Business Mailing Address
First Line : 1881 FORT CAMPBELL BLVD
Second Line :
City : CLARKSVILLE
State : TN
Zip : 37042-5109
Country : US
Telephone Number : 931-920-0077
Fax Number : 931-920-0058
Provider Business Practice Location Address
First Line : 1881 FORT CAMPBELL BLVD
Second Line :
City : CLARKSVILLE
State : TN
Zip : 37042-5109
Country : US
Telephone Number : 931-920-0077
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/18/2021
Last Update Date : 11/18/2021

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Directions to “ DEPAUL NICHOLS ” Practice Location

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