Provider Demographics
NPI:1407265028
Name:JOAQUIN, NICOLE (DC)
Entity Type:Individual
Prefix:MRS
First Name:NICOLE
Middle Name:
Last Name:JOAQUIN
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 1:4542 SEVEN HILLS RD
Mailing Address - Street 2:
Mailing Address - City:CASTRO VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:94546-3110
Mailing Address - Country:US
Mailing Address - Phone:510-589-3829
Mailing Address - Fax:
Practice Address - Street 1:2329A EAGLE AVE
Practice Address - Street 2:
Practice Address - City:ALAMEDA
Practice Address - State:CA
Practice Address - Zip Code:94501-1408
Practice Address - Country:US
Practice Address - Phone:510-769-0125
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-08-07
Last Update Date:2014-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA33019111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor