Individual
PHILIP RAY NICKOLS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
1 UNIVERSITY CIR, MACOMB, IL 61455
(309) 298-2138
Mailing address
1 UNIVERSITY CIR, MACOMB, IL 61455-1367
(309) 298-2138
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
096.003810
IL
Other
Enumeration date
07/28/2017
Last updated
07/21/2022
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