Provider Demographics
NPI:1518000264
Name:CORRADINO, NICOLE ANN (DC)
Entity Type:Individual
Prefix:DR
First Name:NICOLE
Middle Name:ANN
Last Name:CORRADINO
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 1:228 N YORK RD STE C
Mailing Address - Street 2:
Mailing Address - City:HATBORO
Mailing Address - State:PA
Mailing Address - Zip Code:19040-2600
Mailing Address - Country:US
Mailing Address - Phone:215-444-9119
Mailing Address - Fax:215-444-9331
Practice Address - Street 1:228 N YORK RD STE C
Practice Address - Street 2:
Practice Address - City:HATBORO
Practice Address - State:PA
Practice Address - Zip Code:19040-2600
Practice Address - Country:US
Practice Address - Phone:215-444-9119
Practice Address - Fax:215-444-9331
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-14
Last Update Date:2012-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC-008973111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1441424OtherBCBS PERSONAL CHOICE
PA1051629OtherAMERICAN SPECIALTY HEALTH
PA1130203OtherAETNA
PA2125288000OtherKEYSTONE (BCBS)