Individual
LARRY NICKELSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DC
Contact information
Practice address
207 E 3RD ST, MILLER, SD 57362-1426
(605) 853-2230
(605) 853-3111
Mailing address
207 E 3RD ST, MILLER, SD 57362-1426
(605) 853-2230
(605) 853-3111
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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