Provider Demographics
NPI:1851752232
Name:WESTBROOK, NICOLE MARIE (DC)
Entity Type:Individual
Prefix:DR
First Name:NICOLE
Middle Name:MARIE
Last Name:WESTBROOK
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:NICOLE-MARIE
Other - Middle Name:
Other - Last Name:WESTBROOK
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DC
Mailing Address - Street 1:PO BOX 81
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:OR
Mailing Address - Zip Code:97477-0005
Mailing Address - Country:US
Mailing Address - Phone:931-224-3893
Mailing Address - Fax:541-747-1535
Practice Address - Street 1:90971 S WILLAMETTE ST
Practice Address - Street 2:
Practice Address - City:COBURG
Practice Address - State:OR
Practice Address - Zip Code:97408
Practice Address - Country:US
Practice Address - Phone:833-628-5433
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-03-14
Last Update Date:2020-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
103K00000X
OR5838111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
No103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst