Provider Demographics
NPI:1023508108
Name:OLREE, NICOLETTE BROOKE (DC, LAC)
Entity type:Individual
Prefix:DR
First Name:NICOLETTE
Middle Name:BROOKE
Last Name:OLREE
Suffix:
Gender:F
Credentials:DC, LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1965 COUNTY HOUSE RD APT B
Mailing Address - Street 2:
Mailing Address - City:WATERLOO
Mailing Address - State:NY
Mailing Address - Zip Code:13165-9470
Mailing Address - Country:US
Mailing Address - Phone:989-255-6512
Mailing Address - Fax:
Practice Address - Street 1:669 ROUTE 31
Practice Address - Street 2:
Practice Address - City:MACEDON
Practice Address - State:NY
Practice Address - Zip Code:14502-9107
Practice Address - Country:US
Practice Address - Phone:315-310-5538
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-05-15
Last Update Date:2018-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX012895-1111N00000X
NY006254-1171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
No111N00000XChiropractic ProvidersChiropractor