Healthcare Provider Details

I. General information

NPI: 1831307347
Provider Name (Legal Business Name): JOSEPH ROBERT NICOLA D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/18/2007
Last Update Date: 07/28/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7380 W SAHARA AVE SUITE 100
LAS VEGAS NV
89117-2760
US

IV. Provider business mailing address

7380 W SAHARA AVE SUITE 100
LAS VEGAS NV
89117-2760
US

V. Phone/Fax

Practice location:
  • Phone: 702-252-7246
  • Fax: 702-251-9650
Mailing address:
  • Phone: 702-252-7246
  • Fax: 702-251-9650

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NI0013X
TaxonomyIndependent Medical Examiner Chiropractor
License NumberB-916
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: