MEDICARE: DR. NICHOLAS M DORE PH.D

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	171100000X	Acupuncturist	L.AC.023	AR

General Provider Information

NPI Number	:	1659963890
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. NICHOLAS M DORE PH.D

Provider Business Mailing Address
First Line	:	15 GABRIEL WAY
Second Line	:
City	:	SULPHUR ROCK
State	:	AR
Zip	:	72579-9012
Country	:	US
Telephone Number	:	870-656-8646
Fax Number	:

Provider Business Practice Location Address
First Line	:	15 GABRIEL WAY
Second Line	:
City	:	SULPHUR ROCK
State	:	AR
Zip	:	72579-9012
Country	:	US
Telephone Number	:	870-656-8646
Fax Number	:

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

Provider Enumeration Date	:	02/09/2021
Last Update Date	:	02/09/2021

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