Indiana
Professional Licensing Agency
Richard K. Niccum
Controlled Substance Registration - Physician
License number
01037769B
Date granted
07/03/1989
Date expires
10/31/2015
Class
Controlled Substance Registration - Physician
Status
Active
Address
3460 NORTH STATE ROAD 109, COLUMBIA CITY IN 46725
indianalicensing.org
ID 5835670
LAST UPDATED 2024-04-21 21:07:56 UTC
LAST UPDATED 2024-04-21 21:07:56 UTC
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