Provider Demographics
NPI:1134561756
Name:LOPEZ, NICOLE ALLISON (DC)
Entity type:Individual
Prefix:
First Name:NICOLE
Middle Name:ALLISON
Last Name:LOPEZ
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 1:30 CALLE EL FERROL
Mailing Address - Street 2:CIUDAD JARDIN BAIROA
Mailing Address - City:CAGUAS
Mailing Address - State:PR
Mailing Address - Zip Code:00727-1326
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:# 25 AVE. DEGETAU
Practice Address - Street 2:
Practice Address - City:CAGUAS
Practice Address - State:PR
Practice Address - Zip Code:00725-5819
Practice Address - Country:US
Practice Address - Phone:787-510-1110
Practice Address - Fax:939-204-9504
Is Sole Proprietor?:No
Enumeration Date:2013-07-24
Last Update Date:2014-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR514111N00000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR660820670OtherIRS