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General NPI Number Information
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NPI Number | 1528007036
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Entity Type | Individual
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Provider Name | JACK CLIFFORD NICHOLS II MD
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Gender | Male
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Dates
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Enumeration Date | 06/06/2006
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Last Update Date | 03/28/2008
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Provider Practice Location Address
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Address Line | 1230 EAST ST SUITE A
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City | REDDING
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State | CA
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Zip | 96001-0821
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Country | US
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Telephone | 530-246-2430
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Fax | 530-246-1907
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Provider Business Mailing Address
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Address Line | PO BOX 848914
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City | BOSTON
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State | MA
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Zip | 02284-8914
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Country | US
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Telephone | 530-246-2430
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Fax | 530-246-1907
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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 | 207X00000X
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Taxonomy Name | Orthopaedic Surgery Physician
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License Number | G35731
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License Number State | CA
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