Provider Demographics
NPI:1992867139
Name:HEWITT, NICOLE MICHELLE (DC)
Entity Type:Individual
Prefix:DR
First Name:NICOLE
Middle Name:MICHELLE
Last Name:HEWITT
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 1:301 LINDEN ST
Mailing Address - Street 2:
Mailing Address - City:ANGLETON
Mailing Address - State:TX
Mailing Address - Zip Code:77515-3234
Mailing Address - Country:US
Mailing Address - Phone:979-997-0168
Mailing Address - Fax:979-864-3450
Practice Address - Street 1:301 LINDEN ST
Practice Address - Street 2:
Practice Address - City:ANGLETON
Practice Address - State:TX
Practice Address - Zip Code:77515-3234
Practice Address - Country:US
Practice Address - Phone:979-997-0168
Practice Address - Fax:979-864-3450
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX9704111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor