Provider Demographics
NPI:1336218361
Name:MCDONALD, NICOLE MARY (DC)
Entity Type:Individual
Prefix:DR
First Name:NICOLE
Middle Name:MARY
Last Name:MCDONALD
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 1:211 HURLEY AVE STE 5
Mailing Address - Street 2:
Mailing Address - City:KINGSTON
Mailing Address - State:NY
Mailing Address - Zip Code:12401-2415
Mailing Address - Country:US
Mailing Address - Phone:845-331-6653
Mailing Address - Fax:845-331-3892
Practice Address - Street 1:211 HURLEY AVE STE 5
Practice Address - Street 2:
Practice Address - City:KINGSTON
Practice Address - State:NY
Practice Address - Zip Code:12401-2415
Practice Address - Country:US
Practice Address - Phone:845-331-6653
Practice Address - Fax:845-246-0414
Is Sole Proprietor?:No
Enumeration Date:2006-11-06
Last Update Date:2023-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX010524111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
U94628Medicare UPIN
NYX54832Medicare ID - Type Unspecified