Provider Demographics
NPI:1902956477
Name:WHITEHEAD, NICOLE A (DC)
Entity Type:Individual
Prefix:DR
First Name:NICOLE
Middle Name:A
Last Name:WHITEHEAD
Suffix:
Gender:F
Credentials:DC
Other - Prefix:DR
Other - First Name:NICOLE
Other - Middle Name:RENE
Other - Last Name:ANDERSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DC
Mailing Address - Street 1:444 WILLIAMSON RD STE C
Mailing Address - Street 2:
Mailing Address - City:MOORESVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28117-9248
Mailing Address - Country:US
Mailing Address - Phone:734-673-0135
Mailing Address - Fax:
Practice Address - Street 1:444 WILLIAMSON RD STE C
Practice Address - Street 2:
Practice Address - City:MOORESVILLE
Practice Address - State:NC
Practice Address - Zip Code:28117-9248
Practice Address - Country:US
Practice Address - Phone:704-663-5142
Practice Address - Fax:704-663-5197
Is Sole Proprietor?:No
Enumeration Date:2007-01-10
Last Update Date:2022-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC3495111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor