Provider Demographics
NPI:1518667658
Name:DR NICOLE CHIROPRACTIC AND REHAB
Entity Type:Organization
Organization Name:DR NICOLE CHIROPRACTIC AND REHAB
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR OF CHIROPRACTIC/ OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:NICOLE
Authorized Official - Middle Name:
Authorized Official - Last Name:MINATREA
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:682-710-3126
Mailing Address - Street 1:105 W RENO RD
Mailing Address - Street 2:
Mailing Address - City:AZLE
Mailing Address - State:TX
Mailing Address - Zip Code:76020-6001
Mailing Address - Country:US
Mailing Address - Phone:682-710-3126
Mailing Address - Fax:817-887-2511
Practice Address - Street 1:4300 BOAT CLUB RD STE 100
Practice Address - Street 2:
Practice Address - City:LAKE WORTH
Practice Address - State:TX
Practice Address - Zip Code:76135-2589
Practice Address - Country:US
Practice Address - Phone:682-710-3126
Practice Address - Fax:817-887-2511
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-03-07
Last Update Date:2023-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty