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General NPI Number Information
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NPI Number | 1013965813
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Entity Type | Individual
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Provider Name | BRIAN E NICHOLS MS ATC
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Gender | Male
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Dates
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Enumeration Date | 05/04/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 2300 GENOA BUSINESS PARK DR SUITE 120
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City | BRIGHTON
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State | MI
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Zip | 48114-7367
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Country | US
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Telephone | 810-299-8557
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Fax |
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Provider Business Mailing Address
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Address Line | 749 VILLAGE DR
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City | FOWLERVILLE
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State | MI
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Zip | 48836-7930
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Country | US
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Telephone | 517-223-1070
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2255A2300X
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Taxonomy Name | Athletic Trainer
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License Number |
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License Number State |
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