Provider Demographics
NPI:1063716421
Name:DEAN H NICHOLSON PC
Entity type:Organization
Organization Name:DEAN H NICHOLSON PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:DEAN
Authorized Official - Middle Name:
Authorized Official - Last Name:NICHOLSON
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:412-440-0490
Mailing Address - Street 1:4411 STILLEY RD
Mailing Address - Street 2:
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15227-1368
Mailing Address - Country:US
Mailing Address - Phone:412-440-0490
Mailing Address - Fax:412-440-0493
Practice Address - Street 1:4411 STILLEY RD
Practice Address - Street 2:
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15227-1368
Practice Address - Country:US
Practice Address - Phone:412-440-0490
Practice Address - Fax:412-440-0493
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-12-28
Last Update Date:2011-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA7833L111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0019444200002Medicaid
PA0019444200002Medicaid