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General NPI Number Information
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NPI Number | 1548405632
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Entity Type | Individual
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Provider Name | KATRINA RUTH NICHOLSON D.C
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Gender | Female
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Dates
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Enumeration Date | 12/03/2008
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Last Update Date | 10/18/2016
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Provider Practice Location Address
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Address Line | 500 PERRY RD STE 202
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City | GRAND BLANC
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State | MI
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Zip | 48439-1421
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Country | US
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Telephone | 810-771-7624
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Fax |
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Provider Business Mailing Address
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Address Line | 500 PERRY RD STE 202
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City | GRAND BLANC
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State | MI
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Zip | 48439-1421
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Country | US
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Telephone | 810-771-7624
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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 | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | 038011292
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License Number State | IL
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