Healthcare Provider Details

I. General information

NPI: 1124292198
Provider Name (Legal Business Name): NICOLE SMITH USSERY D.C., M.AE, RD, LD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/21/2008
Last Update Date: 04/21/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1070 MONTGOMERY HWY
VESTAVIA HILLS AL
35216-2806
US

IV. Provider business mailing address

1070 MONTGOMERY HWY
VESTAVIA HILLS AL
35216-2806
US

V. Phone/Fax

Practice location:
  • Phone: 205-823-7890
  • Fax: 205-978-3693
Mailing address:
  • Phone: 205-823-7890
  • Fax: 205-978-3693

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NN1001X
TaxonomyNutrition Chiropractor
License Number2243
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: