Provider Demographics
NPI:1619983103
Name:PAXTON, NICOLE GEORGETTE (DC)
Entity Type:Individual
Prefix:DR
First Name:NICOLE
Middle Name:GEORGETTE
Last Name:PAXTON
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 1:255 S 36TH ST STE 400
Mailing Address - Street 2:
Mailing Address - City:QUINCY
Mailing Address - State:IL
Mailing Address - Zip Code:62301-5806
Mailing Address - Country:US
Mailing Address - Phone:217-214-2554
Mailing Address - Fax:217-214-2555
Practice Address - Street 1:255 S 36TH ST STE 400
Practice Address - Street 2:
Practice Address - City:QUINCY
Practice Address - State:IL
Practice Address - Zip Code:62301-5806
Practice Address - Country:US
Practice Address - Phone:217-214-2554
Practice Address - Fax:217-214-2555
Is Sole Proprietor?:No
Enumeration Date:2006-08-01
Last Update Date:2018-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038.010422111N00000X
IL038-010422111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL0030140272OtherBCBS
ILK18781Medicare ID - Type Unspecified
IL0030140272OtherBCBS