Provider Demographics
NPI:1366676637
Name:KORMAN, NICOLE ANNE (DC)
Entity Type:Individual
Prefix:DR
First Name:NICOLE
Middle Name:ANNE
Last Name:KORMAN
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 1:47 N WATERVILLE AVE
Mailing Address - Street 2:
Mailing Address - City:LE CENTER
Mailing Address - State:MN
Mailing Address - Zip Code:56057-1522
Mailing Address - Country:US
Mailing Address - Phone:612-481-9647
Mailing Address - Fax:
Practice Address - Street 1:47 N WATERVILLE AVE
Practice Address - Street 2:
Practice Address - City:LE CENTER
Practice Address - State:MN
Practice Address - Zip Code:56057-1522
Practice Address - Country:US
Practice Address - Phone:612-481-9647
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-05-14
Last Update Date:2009-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN5176111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor