Provider Demographics
NPI:1669060638
Name:HOLT, NICOLE M (DC)
Entity type:Individual
Prefix:
First Name:NICOLE
Middle Name:M
Last Name:HOLT
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 1:21 DAIGLE LN STE 103
Mailing Address - Street 2:
Mailing Address - City:SANFORD
Mailing Address - State:ME
Mailing Address - Zip Code:04073-3939
Mailing Address - Country:US
Mailing Address - Phone:207-324-7098
Mailing Address - Fax:
Practice Address - Street 1:21 DAIGLE LN STE 103
Practice Address - Street 2:
Practice Address - City:SANFORD
Practice Address - State:ME
Practice Address - Zip Code:04073-3939
Practice Address - Country:US
Practice Address - Phone:207-324-7098
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-06
Last Update Date:2021-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME2692111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty