Healthcare Provider Details

I. General information

NPI: 1154331072
Provider Name (Legal Business Name): ROBERT MATTHEW NOLAN D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/09/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

601 N SHORE DR SUITE 101
JEFFERSONVILLE IN
47130-3142
US

IV. Provider business mailing address

601 N SHORE DR SUITE 101
JEFFERSONVILLE IN
47130-3142
US

V. Phone/Fax

Practice location:
  • Phone: 812-288-8800
  • Fax:
Mailing address:
  • Phone: 812-288-8800
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number08002150A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: