Provider Demographics
NPI:1174530760
Name:NICKELS, STEVEN MICHAEL (DC DACBN)
Entity type:Individual
Prefix:DR
First Name:STEVEN
Middle Name:MICHAEL
Last Name:NICKELS
Suffix:
Gender:M
Credentials:DC DACBN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9891 SAN JOSE BLVD
Mailing Address - Street 2:STE 2
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32257
Mailing Address - Country:US
Mailing Address - Phone:904-262-8600
Mailing Address - Fax:904-262-3899
Practice Address - Street 1:9891 SAN JOSE BLVD
Practice Address - Street 2:STE 2
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32257
Practice Address - Country:US
Practice Address - Phone:904-262-8600
Practice Address - Fax:904-262-3899
Is Sole Proprietor?:No
Enumeration Date:2006-08-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH0006361111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
228424Medicare ID - Type Unspecified
U81607Medicare UPIN