MEDICARE: NICHOLS CHIROPRACTIC, PLC

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	06453	IA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	04192	OTHER	IA	WELLMARK BLUE CROSS BLUE SHIELD
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1629245451
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NICHOLS CHIROPRACTIC, PLC

Provider Business Mailing Address
First Line	:	308 MAIN ST
Second Line	:	PO BOX 130
City	:	JANESVILLE
State	:	IA
Zip	:	50647-7785
Country	:	US
Telephone Number	:	319-987-3080
Fax Number	:	319-987-3080

Provider Business Practice Location Address
First Line	:	308 MAIN ST
Second Line	:
City	:	JANESVILLE
State	:	IA
Zip	:	50647-7785
Country	:	US
Telephone Number	:	319-987-3080
Fax Number	:	319-987-3080

Authorized Official
Title or Position	:	OWNER/CHIROPRACTOR
Name	:	DR. PAUL DAVID NICHOLS
Credential	:	D.C.
Telephone Number	:	319-987-3080

Provider Enumeration Date	:	05/12/2008
Last Update Date	:	08/05/2008

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