Healthcare Provider Details

I. General information

NPI: 1033110804
Provider Name (Legal Business Name): LAWRENCE S NICHOLS III D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/03/2005
Last Update Date: 05/06/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2696 HWY 77 S
MARION AR
72364-2373
US

IV. Provider business mailing address

2696 HWY 77 S
MARION AR
72364-2373
US

V. Phone/Fax

Practice location:
  • Phone: 870-739-2500
  • Fax: 870-739-4979
Mailing address:
  • Phone: 870-739-2500
  • Fax: 870-739-4979

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number1297
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: