# NICODEMUS MEDICAL CORPORATION

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Advanced Osteopathy
- **Organization subpart:** No

## Provider details

- **NPI number:** 1083026397
- **Authorized official:** DR. CLARENCE LYN NICODEMUS D.O. PHD. (PRESIDENT, MEDICAL DIRECTOR)
- **Authorized official phone:** (831) 644-9614

## Contact information

- **Practice address:** 910 MAJOR SHERMAN LN, SUITE 300, MONTEREY, CA 93940-4642
- **Practice address phone:** (831) 664-9614
- **Practice address fax:** (831) 644-9615
- **Mailing address:** 910 MAJOR SHERMAN LN, SUITE 300, MONTEREY, CA 93940-4642
- **Mailing address phone:** (831) 664-9614
- **Mailing address fax:** (831) 644-9615

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 204D00000X | Neuromusculoskeletal Medicine & OMM Physician | 20A10296 | CA | Yes |

## Other

- **Enumeration date:** 05/21/2014
- **Last updated:** 01/14/2015