Provider Demographics
NPI:1720358153
Name:SCHULTZ, NICHOLE RENE (DC)
Entity Type:Individual
Prefix:MRS
First Name:NICHOLE
Middle Name:RENE
Last Name:SCHULTZ
Suffix:
Gender:F
Credentials:DC
Other - Prefix:MISS
Other - First Name:NICHOLE
Other - Middle Name:RENE
Other - Last Name:YARD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DC
Mailing Address - Street 1:1372N 59TH ST
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53208-2140
Mailing Address - Country:US
Mailing Address - Phone:309-335-6618
Mailing Address - Fax:
Practice Address - Street 1:17280 W NORTH AVE STE G102
Practice Address - Street 2:
Practice Address - City:BROOKFIELD
Practice Address - State:WI
Practice Address - Zip Code:53045-4367
Practice Address - Country:US
Practice Address - Phone:262-789-0576
Practice Address - Fax:262-789-5357
Is Sole Proprietor?:No
Enumeration Date:2012-01-02
Last Update Date:2019-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI4740-12111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor