Individual
DR. LARRY E NICHOLSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.C.
Contact information
Practice address
1011 PARKER AVE, TRACY, CA 95376
(209) 836-0250
(209) 836-5037
Mailing address
1011 PARKER AVE, TRACY, CA 95376
(209) 836-0250
(209) 836-5037
Taxonomy
Speciality
Code
Description
License number
State
111NS0005X
Sports Physician Chiropractor
Primary
17771
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
DC0177710
BLUE SHIELD
CA
Enumeration date
11/13/2006
Last updated
07/08/2007
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