Provider Demographics
NPI:1952607632
Name:SYVERTSON, NICOL LEA (MASSAGE THERAPIST)
Entity Type:Individual
Prefix:
First Name:NICOL
Middle Name:LEA
Last Name:SYVERTSON
Suffix:
Gender:F
Credentials:MASSAGE THERAPIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3931 STONEGRASS PT
Mailing Address - Street 2:
Mailing Address - City:BROOMFIELD
Mailing Address - State:CO
Mailing Address - Zip Code:80023-4022
Mailing Address - Country:US
Mailing Address - Phone:720-329-5687
Mailing Address - Fax:
Practice Address - Street 1:5140 W 120TH AVE UNIT 100
Practice Address - Street 2:
Practice Address - City:WESTMINSTER
Practice Address - State:CO
Practice Address - Zip Code:80020-3336
Practice Address - Country:US
Practice Address - Phone:303-451-6706
Practice Address - Fax:303-451-6706
Is Sole Proprietor?:Yes
Enumeration Date:2011-01-28
Last Update Date:2011-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO7684111NR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NR0400XChiropractic ProvidersChiropractorRehabilitation