Individual
DR. GLENN NICHOLAS JR.
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.C.
Contact information
Practice address
315 SKYLINE DR, LEWISTON, ID 83501-4220
(208) 743-4556
Mailing address
315 SKYLINE DR, LEWISTON, ID 83501-4220
(208) 743-4567
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
Primary
CHIA-760
ID
Other
Enumeration date
03/30/2007
Last updated
07/08/2007
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