Provider Demographics
NPI:1730266644
Name:RICHARSON-SICRE, NICOLE DANIELLE (DC)
Entity type:Individual
Prefix:DR
First Name:NICOLE
Middle Name:DANIELLE
Last Name:RICHARSON-SICRE
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 1:13224 SR 64
Mailing Address - Street 2:
Mailing Address - City:BRADENTON
Mailing Address - State:FL
Mailing Address - Zip Code:34212-9403
Mailing Address - Country:US
Mailing Address - Phone:941-777-2739
Mailing Address - Fax:941-225-8496
Practice Address - Street 1:13224 SR 64
Practice Address - Street 2:
Practice Address - City:BRADENTON
Practice Address - State:FL
Practice Address - Zip Code:34212-9403
Practice Address - Country:US
Practice Address - Phone:571-220-1362
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-01
Last Update Date:2024-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH13984111N00000X, 111NR0400X
VA0104555806111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NR0400XChiropractic ProvidersChiropractorRehabilitation
No111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA010687814OtherTAX ID