Provider Demographics
NPI:1487194288
Name:SHABINO, NICOLE (DC)
Entity Type:Individual
Prefix:DR
First Name:NICOLE
Middle Name:
Last Name:SHABINO
Suffix:
Gender:F
Credentials:DC
Other - Prefix:DR
Other - First Name:NICOLE
Other - Middle Name:
Other - Last Name:STESSMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DC
Mailing Address - Street 1:3209 INGERSOLL AVE
Mailing Address - Street 2:SUITE 112
Mailing Address - City:DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50312-3929
Mailing Address - Country:US
Mailing Address - Phone:515-321-6252
Mailing Address - Fax:
Practice Address - Street 1:3209 INGERSOLL AVE
Practice Address - Street 2:SUITE 112
Practice Address - City:DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50312-3929
Practice Address - Country:US
Practice Address - Phone:515-321-6252
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-02-28
Last Update Date:2017-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA007661111N00000X, 111NP0017X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NP0017XChiropractic ProvidersChiropractorPediatric Chiropractor
No111N00000XChiropractic ProvidersChiropractor