Provider Demographics
NPI:1134289077
Name:NICOLETTI SHEPPARD, LAURIE (DC)
Entity type:Individual
Prefix:DR
First Name:LAURIE
Middle Name:
Last Name:NICOLETTI SHEPPARD
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 1:171 RIDGEDALE AVE
Mailing Address - Street 2:SUITE A
Mailing Address - City:FLORHAM PARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07932-1764
Mailing Address - Country:US
Mailing Address - Phone:973-377-6327
Mailing Address - Fax:973-408-9055
Practice Address - Street 1:171 RIDGEDALE AVE
Practice Address - Street 2:SUITE A
Practice Address - City:FLORHAM PARK
Practice Address - State:NJ
Practice Address - Zip Code:07932-1764
Practice Address - Country:US
Practice Address - Phone:973-377-6327
Practice Address - Fax:973-408-9055
Is Sole Proprietor?:No
Enumeration Date:2006-12-11
Last Update Date:2008-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ38MC00419500111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor