Provider Demographics
NPI:1891151163
Name:THOMAS, NICOLE A (DC)
Entity Type:Individual
Prefix:
First Name:NICOLE
Middle Name:A
Last Name:THOMAS
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:418 BEAVERCREEK RD STE 102
Mailing Address - Street 2:
Mailing Address - City:OREGON CITY
Mailing Address - State:OR
Mailing Address - Zip Code:97045-4287
Mailing Address - Country:US
Mailing Address - Phone:503-723-4462
Mailing Address - Fax:503-723-4458
Practice Address - Street 1:418 BEAVERCREEK RD STE 102
Practice Address - Street 2:
Practice Address - City:OREGON CITY
Practice Address - State:OR
Practice Address - Zip Code:97045-4287
Practice Address - Country:US
Practice Address - Phone:503-860-8112
Practice Address - Fax:503-723-4458
Is Sole Proprietor?:No
Enumeration Date:2016-01-02
Last Update Date:2017-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR10672225700000X
OR5785111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
No225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist