Provider Demographics
NPI:1265481709
Name:GILKEY-NICOL, STEPHANNIE DAWN (DC)
Entity Type:Individual
Prefix:MS
First Name:STEPHANNIE
Middle Name:DAWN
Last Name:GILKEY-NICOL
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 1:412 PENNSYLVANIA AVE
Mailing Address - Street 2:
Mailing Address - City:HOLTON
Mailing Address - State:KS
Mailing Address - Zip Code:66436-1803
Mailing Address - Country:US
Mailing Address - Phone:785-364-9003
Mailing Address - Fax:785-364-9006
Practice Address - Street 1:412 PENNSYLVANIA AVE
Practice Address - Street 2:
Practice Address - City:HOLTON
Practice Address - State:KS
Practice Address - Zip Code:66436-1803
Practice Address - Country:US
Practice Address - Phone:785-364-9003
Practice Address - Fax:785-364-9006
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-10
Last Update Date:2012-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS01-04759111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS062143OtherBCBS OF KANSAS
KS062143Medicare ID - Type Unspecified