Individual
EVAN A. NICHOLAS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DO
Contact information
Practice address
4190 CITY LINE AVE, PHILADELPHIA, PA 19131-1626
(215) 871-6425
(215) 871-6490
Mailing address
4190 CITY LINE AVE, PHILADELPHIA, PA 19131-1626
(215) 871-6425
(215) 871-6490
Taxonomy
Speciality
Code
Description
License number
State
204D00000X
Neuromusculoskeletal Medicine & OMM Physician
Primary
OS004962L
PA
Other
Enumeration date
08/11/2005
Last updated
02/01/2016
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