Provider Demographics
NPI:1083769715
Name:HALKOVIC, NICOLE MONIQUE (DC)
Entity Type:Individual
Prefix:DR
First Name:NICOLE
Middle Name:MONIQUE
Last Name:HALKOVIC
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 1:1121 CHURCH ST
Mailing Address - Street 2:SUITE B
Mailing Address - City:ZACHARY
Mailing Address - State:LA
Mailing Address - Zip Code:70791-2377
Mailing Address - Country:US
Mailing Address - Phone:225-654-0048
Mailing Address - Fax:225-654-9906
Practice Address - Street 1:1121B CHURCH ST
Practice Address - Street 2:
Practice Address - City:ZACHARY
Practice Address - State:LA
Practice Address - Zip Code:70791
Practice Address - Country:US
Practice Address - Phone:225-654-0048
Practice Address - Fax:225-654-9906
Is Sole Proprietor?:No
Enumeration Date:2007-01-24
Last Update Date:2012-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA991111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1982482Medicaid
LA5T219Medicare ID - Type Unspecified
LA1982482Medicaid