Provider Demographics
NPI:1093486219
Name:STANLEY, NICOLE SHARON (DC)
Entity Type:Individual
Prefix:DR
First Name:NICOLE
Middle Name:SHARON
Last Name:STANLEY
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 1:6104 185TH CT NE APT W304
Mailing Address - Street 2:
Mailing Address - City:REDMOND
Mailing Address - State:WA
Mailing Address - Zip Code:98052-5076
Mailing Address - Country:US
Mailing Address - Phone:262-492-6305
Mailing Address - Fax:
Practice Address - Street 1:10655 NE 4TH ST STE 101
Practice Address - Street 2:
Practice Address - City:BELLEVUE
Practice Address - State:WA
Practice Address - Zip Code:98004-5022
Practice Address - Country:US
Practice Address - Phone:425-455-2225
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-09-27
Last Update Date:2021-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACH61201741111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor