1033110804 NPI number — DR. LAWRENCE S NICHOLS III D.C.

Table of content: DR. LAWRENCE S NICHOLS III D.C. (NPI 1033110804)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1033110804 NPI number — DR. LAWRENCE S NICHOLS III D.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
NICHOLS
Provider First Name:
LAWRENCE
Provider Middle Name:
S
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
III
Provider Credential Text:
D.C.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1033110804
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/06/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2696 HWY 77 S
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MARION
Provider Business Mailing Address State Name:
AR
Provider Business Mailing Address Postal Code:
72364-2373
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
870-739-2500
Provider Business Mailing Address Fax Number:
870-739-4979

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2696 HWY 77 S
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MARION
Provider Business Practice Location Address State Name:
AR
Provider Business Practice Location Address Postal Code:
72364-2373
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
870-739-2500
Provider Business Practice Location Address Fax Number:
870-739-4979
Provider Enumeration Date:
08/03/2005

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 111N00000X , with the licence number:  1297 , registered in the state of AR ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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