Provider Demographics
NPI:1528050887
Name:NICHOLS, DAN (DC)
Entity type:Individual
Prefix:DR
First Name:DAN
Middle Name:
Last Name:NICHOLS
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2005 E HIGHLAND DR
Mailing Address - Street 2:SUITE #213
Mailing Address - City:JONESBORO
Mailing Address - State:AR
Mailing Address - Zip Code:72401-6123
Mailing Address - Country:US
Mailing Address - Phone:870-932-7860
Mailing Address - Fax:870-932-3285
Practice Address - Street 1:2005 E HIGHLAND DR
Practice Address - Street 2:SUITE #213
Practice Address - City:JONESBORO
Practice Address - State:AR
Practice Address - Zip Code:72401-6123
Practice Address - Country:US
Practice Address - Phone:870-932-7860
Practice Address - Fax:870-932-3285
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-22
Last Update Date:2010-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR1099111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR115129718Medicaid
AR59292Medicare ID - Type Unspecified
AR59292Medicare UPIN