Healthcare Provider Details

I. General information

NPI: 1528050887
Provider Name (Legal Business Name): DAN NICHOLS D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/22/2005
Last Update Date: 07/26/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2005 E HIGHLAND DR SUITE #213
JONESBORO AR
72401-6123
US

IV. Provider business mailing address

2005 E HIGHLAND DR SUITE #213
JONESBORO AR
72401-6123
US

V. Phone/Fax

Practice location:
  • Phone: 870-932-7860
  • Fax: 870-932-3285
Mailing address:
  • Phone: 870-932-7860
  • Fax: 870-932-3285

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number1099
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: