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General NPI Number Information
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NPI Number | 1306856752
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Entity Type | Individual
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Provider Name | JOHN STEPHAN NICHOLS
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Gender | Male
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Dates
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Enumeration Date | 08/08/2006
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Last Update Date | 04/23/2018
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Provider Practice Location Address
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Address Line | 11750 W 2ND PL SUITE 255
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City | LAKEWOOD
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State | CO
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Zip | 80228-1575
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Country | US
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Telephone | 720-321-8040
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Fax | 720-321-8041
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Provider Business Mailing Address
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Address Line | PO BOX 6210
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City | FARMINGTON
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State | NM
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Zip | 87499-6210
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Country | US
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Telephone | 505-609-2258
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Fax | 505-609-2259
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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 | 207T00000X
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Taxonomy Name | Neurological Surgery Physician
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License Number | 26919
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License Number State | CO
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