Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NR0400X | Rehabilitation Chiropractor | 6018 | CO |
NPI | 1285756619 |
---|---|
Provider Name | Dr. Antony Matthew Nicholas |
First Address | Centennial, CO 80112-1423 |
Second Address | Centennial, CO 80112-1423 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/04/2007 |
Last Update Date | 12/03/2008 |