Active NPI
Clifford A. Nickel, DC
- Chiropractor
- Kernersville, NC
National Provider Identifier
1366414930
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Chiropractor
- License
- 1302
- Practice address
- 1522 Teague LN
Kernersville, NC 27284-7521 - Phone
- (336) 996-3600
- Fax
- (336) 993-7454
- NPI assigned
- Feb 7, 2006
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Chiropractor | 111N00000X | 1302 | NC | Primary |
Addresses
Primary practice location
1522 Teague LN
Kernersville, NC 27284-7521
Mailing address
1522 Teague LN
Kernersville, NC 27284-7521
Phone (336) 996-3600
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 8908668 | Medicaid | NC |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 1302 | NC | MD | Speech-Language Pathologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1139270400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1266883200000",
"number": "1366414930",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1522 TEAGUE LN",
"city": "KERNERSVILLE",
"state": "NC",
"postal_code": "272847521",
"telephone_number": "336-996-3600",
"fax_number": "336-993-7454"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1522 TEAGUE LN",
"city": "KERNERSVILLE",
"state": "NC",
"postal_code": "272847521",
"telephone_number": "336-996-3600",
"fax_number": "336-993-7454"
}
],
"practiceLocations": [],
"basic": {
"last_name": "NICKEL",
"first_name": "CLIFFORD",
"middle_name": "A.",
"name_prefix": "Dr.",
"credential": "DC",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2006-02-07",
"last_updated": "2010-02-23",
"status": "A"
},
"taxonomies": [
{
"code": "111N00000X",
"taxonomy_group": "",
"desc": "Chiropractor",
"state": "NC",
"license": "1302",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "8908668",
"state": "NC"
}
],
"endpoints": [],
"other_names": []
}Other providers in Kernersville, NC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 23, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.