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General NPI Number Information
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NPI Number | 1871836080
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Entity Type | Organization
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Legal Business Name | NICHOLL CHIROPRACTIC, INC.
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Dates
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Enumeration Date | 04/05/2013
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Last Update Date | 09/25/2019
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Provider Practice Location Address
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Address Line | 2210 LAKE WASHINGTON BLVD STE 130
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City | WEST SACRAMENTO
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State | CA
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Zip | 95691-6425
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Country | US
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Telephone | 916-594-7630
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Fax | 916-538-6771
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Provider Business Mailing Address
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Address Line | 2210 LAKE WASHINGTON BLVD STE 130
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City | WEST SACRAMENTO
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State | CA
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Zip | 95691-6425
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Country | US
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Telephone | 916-594-7630
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Fax |
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Authorized Official
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Title or Position | OWNER / PROVIDER
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Name | DR. TIMOTHY L NICHOLL
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Credential | D.C.
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Telephone | 916-594-7630
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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 | DC32059
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License Number State | CA
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