Healthcare Provider Details

I. General information

NPI: 1104205640
Provider Name (Legal Business Name): NOHL P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/28/2015
Last Update Date: 10/03/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1201 US HIGHWAY 10 W UNIT C
LIVINGSTON MT
59047-9022
US

IV. Provider business mailing address

1201 US HIGHWAY 10 W UNIT C
LIVINGSTON MT
59047-9022
US

V. Phone/Fax

Practice location:
  • Phone: 406-222-4444
  • Fax:
Mailing address:
  • Phone: 406-222-4444
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NN1001X
TaxonomyNutrition Chiropractor
License NumberCHI-CHI-LIC-3449
License Number StateMT

VIII. Authorized Official

Name: DR. DERRICK EARL NOHL
Title or Position: OFFICE DIRECTOR
Credential: D.C.
Phone: 636-751-2459