Active NPI
Stacy Louise Nicholson, D.C.
- Rehabilitation Chiropractor
- Columbia, MD
National Provider Identifier
1508923970
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Rehabilitation Chiropractor
- License
- 01749
- Practice address
- 10015 Old Columbia Rd
Suite B215
Columbia, MD 21046-1703 - Phone
- (410) 312-5454
- NPI assigned
- Jan 3, 2007
- Sex
- Female
- 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 |
|---|---|---|---|---|
| Rehabilitation Chiropractor | 111NR0400X | 01749 | MD | Primary |
Addresses
Primary practice location
10015 Old Columbia Rd
Suite B215
Columbia, MD 21046-1703
Mailing address
9500 Painted Tree Dr
Randallstown, MD 21133-2845
Phone (410) 312-5454
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 |
|---|---|---|---|
| 01749 | MD | MD | Audiologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1167782400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1412640000000",
"number": "1508923970",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "9500 PAINTED TREE DR",
"city": "RANDALLSTOWN",
"state": "MD",
"postal_code": "211332845",
"telephone_number": "410-312-5454"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "10015 OLD COLUMBIA RD",
"address_2": "SUITE B215",
"city": "COLUMBIA",
"state": "MD",
"postal_code": "210461703",
"telephone_number": "410-312-5454"
}
],
"practiceLocations": [],
"basic": {
"last_name": "NICHOLSON",
"first_name": "STACY",
"middle_name": "LOUISE",
"name_prefix": "Dr.",
"credential": "D.C.",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2007-01-03",
"last_updated": "2014-10-07",
"status": "A"
},
"taxonomies": [
{
"code": "111NR0400X",
"taxonomy_group": "",
"desc": "Chiropractor, Rehabilitation",
"state": "MD",
"license": "01749",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Columbia, MD
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 7, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.