Provider Demographics
NPI:1407081391
Name:ADAMSON, NICOLE JUSTINE (DC)
Entity Type:Individual
Prefix:MISS
First Name:NICOLE
Middle Name:JUSTINE
Last Name:ADAMSON
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:4631 WHITMAN LANE SE
Mailing Address - Street 2:SUITE B
Mailing Address - City:LACEY
Mailing Address - State:WA
Mailing Address - Zip Code:98513
Mailing Address - Country:US
Mailing Address - Phone:360-923-1717
Mailing Address - Fax:360-923-0404
Practice Address - Street 1:4631 WHITMAN LANE
Practice Address - Street 2:SUITE B
Practice Address - City:LACEY
Practice Address - State:WA
Practice Address - Zip Code:98513
Practice Address - Country:US
Practice Address - Phone:360-923-1717
Practice Address - Fax:360-923-0404
Is Sole Proprietor?:Yes
Enumeration Date:2009-05-20
Last Update Date:2011-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACH60082274111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor