MEDICARE: MR. NICHOLAS ADAMS SOUTHWORTH DC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor	4208	OH
2	111N00000X	Chiropractor	DC4208	OH

General Provider Information

NPI Number	:	1538421672
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. NICHOLAS ADAMS SOUTHWORTH DC

Provider Business Mailing Address
First Line	:	8076 E. BROAD STREET
Second Line	:
City	:	REYNOLDSBURG
State	:	OH
Zip	:	43068-8024
Country	:	US
Telephone Number	:	614-986-9103
Fax Number	:	614-986-9619

Provider Business Practice Location Address
First Line	:	8076 E. BROAD STREET
Second Line	:
City	:	REYNOLDSBURG
State	:	OH
Zip	:	43068-8024
Country	:	US
Telephone Number	:	614-986-9103
Fax Number	:	614-986-9103

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/14/2012
Last Update Date	:	04/26/2016

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