Provider Demographics
NPI:1356002463
Name:NICHOLS, ALEXA NICOLE (DC)
Entity Type:Individual
Prefix:DR
First Name:ALEXA
Middle Name:NICOLE
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 1:4109 DEAN LAKES BLVD
Mailing Address - Street 2:
Mailing Address - City:SHAKOPEE
Mailing Address - State:MN
Mailing Address - Zip Code:55379-2851
Mailing Address - Country:US
Mailing Address - Phone:612-767-2800
Mailing Address - Fax:
Practice Address - Street 1:4109 DEAN LAKES BLVD
Practice Address - Street 2:
Practice Address - City:SHAKOPEE
Practice Address - State:MN
Practice Address - Zip Code:55379-2851
Practice Address - Country:US
Practice Address - Phone:612-767-2800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-01-02
Last Update Date:2022-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN6943111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor