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Individual
LARRY NICKELSON
Active
Individual
LARRY NICKELSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DC
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
Primary
638
SD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0006716
BSSD
SD
01
—
0080147
BSSD
SD
01
—
4999757
BSSD
SD
01
—
4999850
BSSD
SD
01
—
4999860
BSSD
SD
01
—
512482
AMPPO
SD
05
—
7602080
—
SD
05
—
7602082
—
SD
05
—
7602083
—
SD
05
—
7602084
—
SD
05
—
7602085
—
SD
Enumeration date
03/15/2006
Last updated
01/23/2008
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