Provider Demographics
NPI:1245269323
Name:JASPER, NICOLE CONYERS (DC)
Entity type:Individual
Prefix:DR
First Name:NICOLE
Middle Name:CONYERS
Last Name:JASPER
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 1:1080 S FEDERAL HWY
Mailing Address - Street 2:
Mailing Address - City:BOYNTON BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33435-5614
Mailing Address - Country:US
Mailing Address - Phone:561-272-2000
Mailing Address - Fax:561-272-1111
Practice Address - Street 1:1080 S FEDERAL HWY
Practice Address - Street 2:
Practice Address - City:BOYNTON BEACH
Practice Address - State:FL
Practice Address - Zip Code:33435-5614
Practice Address - Country:US
Practice Address - Phone:561-272-2000
Practice Address - Fax:561-272-1111
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-01
Last Update Date:2020-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH 8220111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor