Provider Demographics
NPI:1700194412
Name:FODEL, NICOLE MARCELLE (DC, LAC)
Entity Type:Individual
Prefix:DR
First Name:NICOLE
Middle Name:MARCELLE
Last Name:FODEL
Suffix:
Gender:F
Credentials:DC, LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:309 S SHARON AMITY RD
Mailing Address - Street 2:SUITE 302
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28211-2978
Mailing Address - Country:US
Mailing Address - Phone:704-326-1088
Mailing Address - Fax:
Practice Address - Street 1:309 S SHARON AMITY RD
Practice Address - Street 2:SUITE 302
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28211-2978
Practice Address - Country:US
Practice Address - Phone:704-326-1088
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-09-15
Last Update Date:2011-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC4119111N00000X
NC590171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
No171100000XOther Service ProvidersAcupuncturist