MEDICARE: DR. NICOLE GAUTHIER DC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor	33002	CA

General Provider Information

NPI Number	:	1801205174
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. NICOLE GAUTHIER DC

Provider Business Mailing Address
First Line	:	1464 W LATIMER AVE
Second Line	:
City	:	CAMPBELL
State	:	CA
Zip	:	95008-1617
Country	:	US
Telephone Number	:	626-388-5073
Fax Number	:

Provider Business Practice Location Address
First Line	:	21730 STEVENS CREEK BLVD STE 102
Second Line	:
City	:	CUPERTINO
State	:	CA
Zip	:	95014-1171
Country	:	US
Telephone Number	:	408-255-2592
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/12/2014
Last Update Date	:	08/12/2014

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