Provider Demographics
NPI:1912410838
Name:SCHULTZE, NICOLLE J (DC)
Entity Type:Individual
Prefix:DR
First Name:NICOLLE
Middle Name:J
Last Name:SCHULTZE
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 1:5609 VICTORIA GARDENS BLVD APT 1603
Mailing Address - Street 2:
Mailing Address - City:PORT ORANGE
Mailing Address - State:FL
Mailing Address - Zip Code:32127-8975
Mailing Address - Country:US
Mailing Address - Phone:727-220-6778
Mailing Address - Fax:
Practice Address - Street 1:3959 S NOVA RD STE 9
Practice Address - Street 2:
Practice Address - City:PORT ORANGE
Practice Address - State:FL
Practice Address - Zip Code:32127-4900
Practice Address - Country:US
Practice Address - Phone:727-220-6778
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-11-14
Last Update Date:2019-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL10469111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor