Provider Demographics
NPI: | 1104205640 |
---|---|
Name: | NOHL P.C. |
Entity type: | Organization |
Organization Name: | NOHL P.C. |
Other - Org Name: | <UNAVAIL> |
Other - Org Type: | |
Authorized Official - Title/Position: | OFFICE DIRECTOR |
Authorized Official - Prefix: | DR |
Authorized Official - First Name: | DERRICK |
Authorized Official - Middle Name: | EARL |
Authorized Official - Last Name: | NOHL |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | DC |
Authorized Official - Phone: | 636-751-2459 |
Mailing Address - Street 1: | 1201 US HIGHWAY 10 W |
Mailing Address - Street 2: | UNIT C |
Mailing Address - City: | LIVINGSTON |
Mailing Address - State: | MT |
Mailing Address - Zip Code: | 59047-9022 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 406-222-4444 |
Mailing Address - Fax: | |
Practice Address - Street 1: | 1201 US HIGHWAY 10 W |
Practice Address - Street 2: | UNIT C |
Practice Address - City: | LIVINGSTON |
Practice Address - State: | MT |
Practice Address - Zip Code: | 59047-9022 |
Practice Address - Country: | US |
Practice Address - Phone: | 406-222-4444 |
Practice Address - Fax: | |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2015-05-28 |
Last Update Date: | 2016-10-03 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
MT | CHI-CHI-LIC-3449 | 111NN1001X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization | Group |
---|---|---|---|---|---|
Yes | 111NN1001X | Chiropractic Providers | Chiropractor | Nutrition | Group - Single Specialty |