Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111N00000X | Chiropractor | 9283 | TX |
N | 111NR0400X | Rehabilitation Chiropractor | 9283 | TX |
N | 111NS0005X | Chiropractic Sports Physician | 9283 | TX |
NPI | 1205058310 |
---|---|
Provider Name | Dr. Baron Tyrone Nickleberry |
First Address | San Antonio, TX 78216-4363 |
Second Address | San Antonio, TX 78216-4363 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/05/2007 |
Last Update Date | 22/08/2008 |