Provider Demographics
NPI:1902252919
Name:NICHOLSON CHIROPRACTIC HEALTH AND WELLNESS LLC
Entity Type:Organization
Organization Name:NICHOLSON CHIROPRACTIC HEALTH AND WELLNESS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:TYLER
Authorized Official - Middle Name:
Authorized Official - Last Name:NICHOLSON
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:724-603-3233
Mailing Address - Street 1:PO BOX 187
Mailing Address - Street 2:
Mailing Address - City:LEISENRING
Mailing Address - State:PA
Mailing Address - Zip Code:15455-0187
Mailing Address - Country:US
Mailing Address - Phone:724-603-3233
Mailing Address - Fax:724-603-3235
Practice Address - Street 1:110 S ARCH ST STE 1A
Practice Address - Street 2:
Practice Address - City:CONNELLSVILLE
Practice Address - State:PA
Practice Address - Zip Code:15425-3515
Practice Address - Country:US
Practice Address - Phone:724-603-3233
Practice Address - Fax:724-603-3235
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-05-09
Last Update Date:2016-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC010841111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty