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1760841621
DEREK NICHOLS
ALAMOSA, CO
NPI
1760841621
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Entity Type
Individual
Gender
Male
Sole Proprietor ?
Yes
Primary Taxonomy
2255A2300X Specialist/Technologist, Athletic Trainer
(Licence: OR 2000018480)
Enumeration Date
2016-02-19
Last Update Date
2016-02-19
Business Address
-- DEREK NICHOLS
117 PONCHA AVE
ALAMOSA, CO 81101-2166
Phone number: 503-779-9322
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Mailing Address
-- DEREK NICHOLS
117 PONCHA AVE
ALAMOSA, CO 81101
Phone number: 503-779-9322
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