Provider Demographics
NPI:1538421672
Name:SOUTHWORTH, NICHOLAS ADAMS (DC)
Entity type:Individual
Prefix:MR
First Name:NICHOLAS
Middle Name:ADAMS
Last Name:SOUTHWORTH
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 1:8076 E. BROAD STREET
Mailing Address - Street 2:
Mailing Address - City:REYNOLDSBURG
Mailing Address - State:OH
Mailing Address - Zip Code:43068-8024
Mailing Address - Country:US
Mailing Address - Phone:614-986-9103
Mailing Address - Fax:614-986-9619
Practice Address - Street 1:8076 E. BROAD STREET
Practice Address - Street 2:
Practice Address - City:REYNOLDSBURG
Practice Address - State:OH
Practice Address - Zip Code:43068-8024
Practice Address - Country:US
Practice Address - Phone:614-986-9103
Practice Address - Fax:614-986-9103
Is Sole Proprietor?:No
Enumeration Date:2012-06-14
Last Update Date:2016-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH4208111N00000X
OHDC4208111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor