Provider Demographics
NPI:1023650223
Name:CARRASQUILLO, NICOLE M (DC)
Entity type:Individual
Prefix:
First Name:NICOLE
Middle Name:M
Last Name:CARRASQUILLO
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:PO BOX 1600
Mailing Address - Street 2:
Mailing Address - City:CIDRA
Mailing Address - State:PR
Mailing Address - Zip Code:00739-1600
Mailing Address - Country:US
Mailing Address - Phone:787-945-9387
Mailing Address - Fax:
Practice Address - Street 1:CARR 172 KM 6.0
Practice Address - Street 2:BO. CANABONCITO
Practice Address - City:CAGUAS
Practice Address - State:PR
Practice Address - Zip Code:00727
Practice Address - Country:US
Practice Address - Phone:787-945-9387
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-10-09
Last Update Date:2020-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR691111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor