Individual
MR. TAD NICKERSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
ATC
Contact information
Practice address
1096 OAKTON MEWS, VIRGINIA BEACH, VA 23464-5355
(757) 581-8112
Mailing address
1096 OAKTON MEWS, VIRGINIA BEACH, VA 23464-5355
(757) 581-8112
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
0126000247
VA
Other
Enumeration date
09/06/2012
Last updated
09/06/2012
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