Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NR0400X | Rehabilitation Chiropractor | CH60112736 | WA |
NPI | 1205166840 |
---|---|
Provider Name | Dr. Egerton Roy Nicholson |
First Address | Blaine, WA 98230-4045 |
Second Address | Blaine, WA 98230-4045 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 04/01/2010 |
Last Update Date | 04/01/2010 |