Provider Demographics
NPI:1912172636
Name:JUNTZ, NICOLE MARIE (DC)
Entity Type:Individual
Prefix:MRS
First Name:NICOLE
Middle Name:MARIE
Last Name:JUNTZ
Suffix:
Gender:F
Credentials:DC
Other - Prefix:MRS
Other - First Name:NICOLE
Other - Middle Name:MARIE
Other - Last Name:REITER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DC
Mailing Address - Street 1:1011 JACKSON LN
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:GA
Mailing Address - Zip Code:30642-4880
Mailing Address - Country:US
Mailing Address - Phone:843-628-5353
Mailing Address - Fax:843-557-1446
Practice Address - Street 1:1011 JACKSON LN
Practice Address - Street 2:
Practice Address - City:GREENSBORO
Practice Address - State:GA
Practice Address - Zip Code:30642-4880
Practice Address - Country:US
Practice Address - Phone:843-628-5353
Practice Address - Fax:843-557-1446
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-23
Last Update Date:2021-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA09369111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor