Provider Demographics
NPI:1013557735
Name:GIESKEN, NICHOLE MARIE
Entity Type:Individual
Prefix:
First Name:NICHOLE
Middle Name:MARIE
Last Name:GIESKEN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 633
Mailing Address - Street 2:
Mailing Address - City:KALIDA
Mailing Address - State:OH
Mailing Address - Zip Code:45853-0633
Mailing Address - Country:US
Mailing Address - Phone:614-314-4987
Mailing Address - Fax:
Practice Address - Street 1:109 S BROAD ST
Practice Address - Street 2:
Practice Address - City:KALIDA
Practice Address - State:OH
Practice Address - Zip Code:45853-2038
Practice Address - Country:US
Practice Address - Phone:614-314-4987
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-01-10
Last Update Date:2020-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHDC-04939111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor