Provider Demographics
NPI:1326080623
Name:NICHOLS, SHERRI LEE (DC)
Entity Type:Individual
Prefix:DR
First Name:SHERRI
Middle Name:LEE
Last Name:NICHOLS
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 1:6943 GILDA CT
Mailing Address - Street 2:
Mailing Address - City:KEYSTONE HEIGHTS
Mailing Address - State:FL
Mailing Address - Zip Code:32656-8021
Mailing Address - Country:US
Mailing Address - Phone:305-304-9639
Mailing Address - Fax:386-272-9991
Practice Address - Street 1:100 SW MAGNOLIA AVE
Practice Address - Street 2:
Practice Address - City:KEYSTONE HEIGHTS
Practice Address - State:FL
Practice Address - Zip Code:32656-9245
Practice Address - Country:US
Practice Address - Phone:352-478-8239
Practice Address - Fax:386-272-9991
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-12
Last Update Date:2023-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA006350111N00000X
FLCH9531111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
35ZCHBLMedicare ID - Type Unspecified
GAU81119Medicare UPIN