Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 213ES0103X | Foot & Ankle Surgery | 2055 | TX |
Y | 213ES0103X | Foot & Ankle Surgery | 225 | SD |
N | 213ES0103X | Foot & Ankle Surgery | 922 | MN |
NPI | 1063856136 |
---|---|
Provider Name | Dr. Adam Hailes Nichols |
First Address | Sioux Falls, SD 57117-5074 |
Second Address | Sioux Falls, SD 57104-4647 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/04/2013 |
Last Update Date | 05/01/2015 |