Healthcare Provider Details

I. General information

NPI: 1275350084
Provider Name (Legal Business Name): JESSE NICHOLS DC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/23/2024
Last Update Date: 07/28/2026
Certification Date: 07/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

700 E PARK BLVD STE 100
PLANO TX
75074-8842
US

IV. Provider business mailing address

700 E PARK BLVD STE 100
PLANO TX
75074-8842
US

V. Phone/Fax

Practice location:
  • Phone: 214-986-3839
  • Fax:
Mailing address:
  • Phone: 214-986-3839
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number16129
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: