Provider Demographics
NPI:1508615287
Name:KELLENBERGER, NICOLETTE (DC)
Entity type:Individual
Prefix:DR
First Name:NICOLETTE
Middle Name:
Last Name:KELLENBERGER
Suffix:
Gender:
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1200 SIXTH AVE STE 203
Mailing Address - Street 2:
Mailing Address - City:BELMONT
Mailing Address - State:CA
Mailing Address - Zip Code:94002-3839
Mailing Address - Country:US
Mailing Address - Phone:650-489-5311
Mailing Address - Fax:
Practice Address - Street 1:1200 SIXTH AVE STE 203
Practice Address - Street 2:
Practice Address - City:BELMONT
Practice Address - State:CA
Practice Address - Zip Code:94002-3839
Practice Address - Country:US
Practice Address - Phone:650-489-5311
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-05-15
Last Update Date:2025-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC36984111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor