Healthcare Provider Details

I. General information

NPI: 1982682233
Provider Name (Legal Business Name): JERRY ANDREW NOLAN JR. DC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/06/2006
Last Update Date: 12/01/2022
Certification Date: 11/29/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

US ARMY MEDDAC BAVARIA UNIT 28037
APO AE
09112
US

IV. Provider business mailing address

US ARMY MEDDAC BAVARIA UNIT 28037
APO AE
09112
US

V. Phone/Fax

Practice location:
  • Phone: 502-624-9832
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number0104556285
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: