MEDICARE: NICKELSON FAMILY CHIROPRACTIC PROFESSIONAL LIMITED LIABILITY COM

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

General Provider Information

NPI Number	:	1982567129
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NICKELSON FAMILY CHIROPRACTIC PROFESSIONAL LIMITED LIABILITY COM

Provider Business Mailing Address
First Line	:	1504 PACO TRL
Second Line	:
City	:	DENTON
State	:	TX
Zip	:	76209-4644
Country	:	US
Telephone Number	:	940-435-1164
Fax Number	:

Provider Business Practice Location Address
First Line	:	1504 PACO TRL
Second Line	:
City	:	DENTON
State	:	TX
Zip	:	76209-4644
Country	:	US
Telephone Number	:	940-435-1164
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	DR. SAMANTHA NICKELSON
Credential	:	DC
Telephone Number	:	940-435-1164

Provider Enumeration Date	:	12/04/2025
Last Update Date	:	03/06/2026

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