Provider Demographics
NPI:1912945486
Name:BENGE, NICOLE MARIE (DC)
Entity Type:Individual
Prefix:DR
First Name:NICOLE
Middle Name:MARIE
Last Name:BENGE
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 1:115 SUGAR BERRY PL
Mailing Address - Street 2:SUITE 119
Mailing Address - City:DALLAS
Mailing Address - State:GA
Mailing Address - Zip Code:30157-7189
Mailing Address - Country:US
Mailing Address - Phone:678-778-6955
Mailing Address - Fax:
Practice Address - Street 1:115 SUGAR BERRY PL
Practice Address - Street 2:SUITE 119
Practice Address - City:DALLAS
Practice Address - State:GA
Practice Address - Zip Code:30157-7189
Practice Address - Country:US
Practice Address - Phone:678-778-6955
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-04
Last Update Date:2012-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA007600111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor