Provider Demographics
NPI:1396771499
Name:POIRIER, NICOLE (DC)
Entity type:Individual
Prefix:DR
First Name:NICOLE
Middle Name:
Last Name:POIRIER
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 1:47101 HAYES RD
Mailing Address - Street 2:
Mailing Address - City:SHELBY TOWNSHIP
Mailing Address - State:MI
Mailing Address - Zip Code:48315-4910
Mailing Address - Country:US
Mailing Address - Phone:586-566-5005
Mailing Address - Fax:586-566-6695
Practice Address - Street 1:47101 HAYES RD
Practice Address - Street 2:
Practice Address - City:SHELBY TOWNSHIP
Practice Address - State:MI
Practice Address - Zip Code:48315-4910
Practice Address - Country:US
Practice Address - Phone:586-566-5005
Practice Address - Fax:586-566-6695
Is Sole Proprietor?:No
Enumeration Date:2006-06-23
Last Update Date:2012-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301007137111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4494212Medicaid
MI95-0E012640OtherBCBSM
MINP007137OtherCOMMERCIAL
MI95-0E012640OtherBCBSM
MINP007137OtherCOMMERCIAL