Provider Demographics
NPI:1083121826
Name:SHORT, NICOLE MELISSA (DC, MS)
Entity Type:Individual
Prefix:DR
First Name:NICOLE
Middle Name:MELISSA
Last Name:SHORT
Suffix:
Gender:F
Credentials:DC, MS
Other - Prefix:DR
Other - First Name:NICOLE
Other - Middle Name:MELISSA
Other - Last Name:LEFTON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DC, MS
Mailing Address - Street 1:325 HOLLY GROVE RD
Mailing Address - Street 2:
Mailing Address - City:LEWIS CENTER
Mailing Address - State:OH
Mailing Address - Zip Code:43035-8721
Mailing Address - Country:US
Mailing Address - Phone:513-470-5076
Mailing Address - Fax:
Practice Address - Street 1:6554 LONGSHORE ST
Practice Address - Street 2:
Practice Address - City:DUBLIN
Practice Address - State:OH
Practice Address - Zip Code:43017-2785
Practice Address - Country:US
Practice Address - Phone:614-681-0195
Practice Address - Fax:614-681-0872
Is Sole Proprietor?:No
Enumeration Date:2018-01-02
Last Update Date:2023-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHDC-04786111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor