Provider Demographics
NPI:1538209275
Name:GAITANIS-IOLI, NICOLE CHRISTINE (DC)
Entity type:Individual
Prefix:DR
First Name:NICOLE
Middle Name:CHRISTINE
Last Name:GAITANIS-IOLI
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 1:3959 E LAMBETH PL
Mailing Address - Street 2:
Mailing Address - City:QUEEN CREEK
Mailing Address - State:AZ
Mailing Address - Zip Code:85140-5126
Mailing Address - Country:US
Mailing Address - Phone:480-205-6951
Mailing Address - Fax:
Practice Address - Street 1:21321 E OCOTILLO RD
Practice Address - Street 2:B105 ROOM 10
Practice Address - City:QUEEN CREEK
Practice Address - State:AZ
Practice Address - Zip Code:85142-5996
Practice Address - Country:US
Practice Address - Phone:480-205-6951
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-08
Last Update Date:2012-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ7159111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZAZ0943220OtherBCBS
AZ83680Medicare ID - Type Unspecified