Provider Demographics
NPI:1427193754
Name:EDWARDS, NICOLE CHICOINE (DC)
Entity Type:Individual
Prefix:
First Name:NICOLE
Middle Name:CHICOINE
Last Name:EDWARDS
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 1:2005 AIRPORT BLVD
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78722
Mailing Address - Country:US
Mailing Address - Phone:512-472-3557
Mailing Address - Fax:512-472-1261
Practice Address - Street 1:2005 AIRPORT BLVD
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78722
Practice Address - Country:US
Practice Address - Phone:512-472-3557
Practice Address - Fax:512-472-1261
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX8951111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8471B8Medicare ID - Type Unspecified
TXU91136Medicare UPIN