Provider Demographics
NPI:1467808931
Name:NICKEL, ALEXANDREA ROBIN (BS, DC)
Entity Type:Individual
Prefix:MISS
First Name:ALEXANDREA
Middle Name:ROBIN
Last Name:NICKEL
Suffix:
Gender:F
Credentials:BS, DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:511 DOVER RD
Mailing Address - Street 2:
Mailing Address - City:TOMS RIVER
Mailing Address - State:NJ
Mailing Address - Zip Code:08757-5404
Mailing Address - Country:US
Mailing Address - Phone:732-966-2818
Mailing Address - Fax:732-399-8688
Practice Address - Street 1:511 DOVER RD STE 3
Practice Address - Street 2:
Practice Address - City:TOMS RIVER
Practice Address - State:NJ
Practice Address - Zip Code:08757
Practice Address - Country:US
Practice Address - Phone:732-966-2818
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-05-13
Last Update Date:2021-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ38MC00734900111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor