Nicodemus Medical Corporation

Primary specialty

Neuromusculoskeletal Medicine & OMM PhysicianTaxonomy code 204D00000X

License

20A10296 Issued in CA

Legal business name

NICODEMUS MEDICAL CORPORATION

Practice address

910 Major Sherman LN
Suite 300
Monterey, CA 93940-4642

Phone

(831) 664-9614

Fax

(831) 644-9615

NPI assigned

May 21, 2014

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Clarence Lyn Nicodemus, D.O. PHD.

Title

President, Medical Director

Phone

(831) 644-9614

Specialties & licenses 1

Addresses

Other names 1

• Advanced Osteopathy Other name

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1400630400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1421193600000",
    "number": "1083026397",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "910 MAJOR SHERMAN LN",
            "address_2": "SUITE 300",
            "city": "MONTEREY",
            "state": "CA",
            "postal_code": "939404642",
            "telephone_number": "831-664-9614",
            "fax_number": "831-644-9615"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "910 MAJOR SHERMAN LN",
            "address_2": "SUITE 300",
            "city": "MONTEREY",
            "state": "CA",
            "postal_code": "939404642",
            "telephone_number": "831-664-9614",
            "fax_number": "831-644-9615"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NICODEMUS MEDICAL CORPORATION",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-05-21",
        "last_updated": "2015-01-14",
        "status": "A",
        "authorized_official_last_name": "NICODEMUS",
        "authorized_official_first_name": "CLARENCE",
        "authorized_official_middle_name": "LYN",
        "authorized_official_title_or_position": "PRESIDENT, MEDICAL DIRECTOR",
        "authorized_official_telephone_number": "831-644-9614",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.O. PHD."
    },
    "taxonomies": [
        {
            "code": "204D00000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Neuromusculoskeletal Medicine & OMM",
            "state": "CA",
            "license": "20A10296",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Advanced Osteopathy",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

• Vy Nguyen, PHARM.D.
• Judd Karl Nicholas, M.D.
• Phyllis Christine Nicholas, R.N.
• Andrea Nicholls
• Millisa Jade Nichols
• Dennis Michael Niekro, NP
• Isabel Yuliana Nieto Ochoa, M.S.
• Amanda Nikiel, PT, DPT
• Avery Carr-Boyd Nilsen, PT
• Michele Denise Anderson Nizza, LM, CPM, CLEC, LCCE

• Neuromusculoskeletal Medicine & OMM Physician in Monterey, CA
• Providers in Monterey, CA by specialty
• Neuromusculoskeletal Medicine & OMM Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 14, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.