Healthcare Provider Details

I. General information

NPI: 1760532246
Provider Name (Legal Business Name): GERALD A NICHOLS D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/10/2007
Last Update Date: 08/06/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

140 N PINE ST
EVART MI
49631-5120
US

IV. Provider business mailing address

140 N PINE ST
EVART MI
49631-5120
US

V. Phone/Fax

Practice location:
  • Phone: 231-734-5684
  • Fax: 231-734-5684
Mailing address:
  • Phone: 231-734-5684
  • Fax: 231-734-5684

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number2301004457
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: