Provider Demographics
NPI:1033202312
Name:NETOLICKY, NANCY KAHLE (DC)
Entity Type:Individual
Prefix:DR
First Name:NANCY
Middle Name:KAHLE
Last Name:NETOLICKY
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3200 16TH AVE SW
Mailing Address - Street 2:SUITE I
Mailing Address - City:CEDAR RAPIDS
Mailing Address - State:IA
Mailing Address - Zip Code:52404-1469
Mailing Address - Country:US
Mailing Address - Phone:319-247-4782
Mailing Address - Fax:319-247-4784
Practice Address - Street 1:3200 16TH AVE SW
Practice Address - Street 2:SUITE I
Practice Address - City:CEDAR RAPIDS
Practice Address - State:IA
Practice Address - Zip Code:52404-1469
Practice Address - Country:US
Practice Address - Phone:319-247-4782
Practice Address - Fax:319-247-4784
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-01
Last Update Date:2011-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAAO5973111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA58418Medicare ID - Type Unspecified