Larry E Nicholson, D.C.

Primary specialty

Sports Physician ChiropractorTaxonomy code 111NS0005X

License

17771 Issued in CA

Practice address

1011 Parker Ave
Tracy, CA 95376

Phone

(209) 836-0250

Fax

(209) 836-5037

NPI assigned

Nov 13, 2006

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in CA

Enrollment records 1

Specialty

Chiropractic

Education

Other, 1986

Medicare assignment

May accept Medicare assignment

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Networks

• BSC 65 PLUS INDIVIDUAL MAPD

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Nicholson Chiropractic a Professional Corporation

  • Chiropractor
  • Tracy, CA
  • NPI 1912124553
  Medicare reassignment NPD Authorized official
• Sutter Tracy Community Hospital

  • General Acute Care Hospital
  • Tracy, CA
  • NPI 1043291164
  NPD (past)

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

{
    "created_epoch": "1163376000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1548332083",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1011 PARKER AVE",
            "city": "TRACY",
            "state": "CA",
            "postal_code": "95376",
            "telephone_number": "209-836-0250",
            "fax_number": "209-836-5037"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1011 PARKER AVE",
            "city": "TRACY",
            "state": "CA",
            "postal_code": "95376",
            "telephone_number": "209-836-0250",
            "fax_number": "209-836-5037"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "NICHOLSON",
        "first_name": "LARRY",
        "middle_name": "E",
        "name_prefix": "Dr.",
        "credential": "D.C.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-11-13",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "111NS0005X",
            "taxonomy_group": "",
            "desc": "Chiropractor, Sports Physician",
            "state": "CA",
            "license": "17771",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE SHIELD",
            "identifier": "DC0177710",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Linda T Nguyen, DSW, LCSW
• Nguyen Hanh Nguyen
• Nichole Nguyen
• Thuy Thanh Nguyen
• Nicholson Chiropractic a Professional Corporation
• Logan Nielsen
• Chandler Nieman
• Vanessa Nightingale, LVN
• Yasmin Nijjar
• Nine Months Birth Services, PC

• Sports Physician Chiropractor in Tracy, CA
• Providers in Tracy, CA by specialty
• Sports Physician Chiropractor in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.