Provider Demographics
NPI:1174925481
Name:NICHOLS, JESSICA ELAINE (DC)
Entity type:Individual
Prefix:DR
First Name:JESSICA
Middle Name:ELAINE
Last Name:NICHOLS
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:545 FREDERICK ST
Mailing Address - Street 2:
Mailing Address - City:SANTA CRUZ
Mailing Address - State:CA
Mailing Address - Zip Code:95062-2635
Mailing Address - Country:US
Mailing Address - Phone:831-426-4325
Mailing Address - Fax:831-426-4327
Practice Address - Street 1:545 FREDERICK ST
Practice Address - Street 2:
Practice Address - City:SANTA CRUZ
Practice Address - State:CA
Practice Address - Zip Code:95062-2635
Practice Address - Country:US
Practice Address - Phone:831-426-4325
Practice Address - Fax:831-426-4327
Is Sole Proprietor?:Yes
Enumeration Date:2014-09-17
Last Update Date:2014-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA32947111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor