Provider Demographics
NPI:1801198973
Name:NICOLE G. PAXTON, DC, SC
Entity Type:Organization
Organization Name:NICOLE G. PAXTON, DC, SC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:NICOLE
Authorized Official - Middle Name:GEORGETTE
Authorized Official - Last Name:PAXTON
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:217-222-4363
Mailing Address - Street 1:521 S 24TH ST
Mailing Address - Street 2:
Mailing Address - City:QUINCY
Mailing Address - State:IL
Mailing Address - Zip Code:62301-5730
Mailing Address - Country:US
Mailing Address - Phone:217-222-4363
Mailing Address - Fax:
Practice Address - Street 1:521 S 24TH ST
Practice Address - Street 2:
Practice Address - City:QUINCY
Practice Address - State:IL
Practice Address - Zip Code:62301-5730
Practice Address - Country:US
Practice Address - Phone:217-222-4363
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-11-23
Last Update Date:2010-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty