Provider Demographics
NPI:1982358644
Name:HOFFMAN, NICOLE JORDAN (DC)
Entity Type:Individual
Prefix:DR
First Name:NICOLE
Middle Name:JORDAN
Last Name:HOFFMAN
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 1:4200 SUNRISE HWY STE 1
Mailing Address - Street 2:
Mailing Address - City:MASSAPEQUA
Mailing Address - State:NY
Mailing Address - Zip Code:11758-5353
Mailing Address - Country:US
Mailing Address - Phone:516-547-1064
Mailing Address - Fax:
Practice Address - Street 1:4200 SUNRISE HWY STE 1
Practice Address - Street 2:
Practice Address - City:MASSAPEQUA
Practice Address - State:NY
Practice Address - Zip Code:11758-5353
Practice Address - Country:US
Practice Address - Phone:516-547-1064
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-02-10
Last Update Date:2022-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY013578111N00000X, 111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY806600220OtherDRIVERS LICENSE NUMBER