Provider Demographics
NPI:1467165894
Name:LICKEI, NICOLE
Entity Type:Individual
Prefix:
First Name:NICOLE
Middle Name:
Last Name:LICKEI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6512 CROOKED CREEK DR
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68516-2960
Mailing Address - Country:US
Mailing Address - Phone:402-432-1037
Mailing Address - Fax:
Practice Address - Street 1:606 N 66TH ST
Practice Address - Street 2:
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68505-2408
Practice Address - Country:US
Practice Address - Phone:402-466-6454
Practice Address - Fax:402-466-7829
Is Sole Proprietor?:No
Enumeration Date:2022-12-30
Last Update Date:2023-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE2149111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor