Healthcare Provider Details

I. General information

NPI: 1730266644
Provider Name (Legal Business Name): NICOLE DANIELLE RICHARSON-SICRE DC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/01/2006
Last Update Date: 02/28/2024
Certification Date: 02/28/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13224 SR 64
BRADENTON FL
34212-9403
US

IV. Provider business mailing address

13224 SR 64
BRADENTON FL
34212-9403
US

V. Phone/Fax

Practice location:
  • Phone: 571-220-1362
  • Fax:
Mailing address:
  • Phone: 941-777-2739
  • Fax: 941-225-8496

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberCH13984
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number0104555806
License Number StateVA
# 3
Primary TaxonomyY
Taxonomy Code111NR0400X
TaxonomyRehabilitation Chiropractor
License NumberCH13984
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: