Healthcare Provider Details

I. General information

NPI: 1972563062
Provider Name (Legal Business Name): RICKY L. NALL D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/24/2006
Last Update Date: 09/28/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8000 US HIGHWAY 287
CHILDRESS TX
79201-7146
US

IV. Provider business mailing address

8000 US HIGHWAY 287
CHILDRESS TX
79201-7146
US

V. Phone/Fax

Practice location:
  • Phone: 940-937-8844
  • Fax: 940-937-8855
Mailing address:
  • Phone: 940-937-8844
  • Fax: 940-937-8855

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number6732
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: