Provider Demographics
NPI:1306389382
Name:GEVOCK, NICHOLE DANIELLE (DC)
Entity Type:Individual
Prefix:DR
First Name:NICHOLE
Middle Name:DANIELLE
Last Name:GEVOCK
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 1:119 W 2ND ST
Mailing Address - Street 2:
Mailing Address - City:OTTUMWA
Mailing Address - State:IA
Mailing Address - Zip Code:52501-2502
Mailing Address - Country:US
Mailing Address - Phone:641-954-8598
Mailing Address - Fax:
Practice Address - Street 1:119 W 2ND ST
Practice Address - Street 2:
Practice Address - City:OTTUMWA
Practice Address - State:IA
Practice Address - Zip Code:52501-2502
Practice Address - Country:US
Practice Address - Phone:641-954-8598
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-11-23
Last Update Date:2017-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA084409111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor