Provider Demographics
NPI:1629225131
Name:QUAL, NICOLE (DC)
Entity Type:Individual
Prefix:DR
First Name:NICOLE
Middle Name:
Last Name:QUAL
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 1:116 4TH AVE N
Mailing Address - Street 2:
Mailing Address - City:CROOKSTON
Mailing Address - State:MN
Mailing Address - Zip Code:56716-1312
Mailing Address - Country:US
Mailing Address - Phone:218-470-2020
Mailing Address - Fax:218-470-2020
Practice Address - Street 1:116 4TH AVE N
Practice Address - Street 2:
Practice Address - City:CROOKSTON
Practice Address - State:MN
Practice Address - Zip Code:56716-1312
Practice Address - Country:US
Practice Address - Phone:218-470-2020
Practice Address - Fax:217-470-2020
Is Sole Proprietor?:No
Enumeration Date:2008-08-26
Last Update Date:2011-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND807111N00000X
MN5247111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor