Provider Demographics
NPI:1871670042
Name:BALL, NICOLE LYNN (DC)
Entity Type:Individual
Prefix:DR
First Name:NICOLE
Middle Name:LYNN
Last Name:BALL
Suffix:
Gender:F
Credentials:DC
Other - Prefix:DR
Other - First Name:NICOLE
Other - Middle Name:LYNN
Other - Last Name:HOLLINRAKE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DC
Mailing Address - Street 1:1201 E 7TH ST STE 100
Mailing Address - Street 2:
Mailing Address - City:ATLANTIC
Mailing Address - State:IA
Mailing Address - Zip Code:50022-1964
Mailing Address - Country:US
Mailing Address - Phone:712-243-5335
Mailing Address - Fax:712-243-3887
Practice Address - Street 1:1201 E 7TH ST STE 100
Practice Address - Street 2:
Practice Address - City:ATLANTIC
Practice Address - State:IA
Practice Address - Zip Code:50022-1964
Practice Address - Country:US
Practice Address - Phone:712-243-5335
Practice Address - Fax:712-243-3887
Is Sole Proprietor?:No
Enumeration Date:2006-11-01
Last Update Date:2021-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2006013086111N00000X
NE1504111N00000X
CO6011111N00000X
IA007067111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA1861471468OtherBCBS
IA1871670042Medicaid
IA1871670042Medicaid