Healthcare Provider Details

I. General information

NPI: 1841842036
Provider Name (Legal Business Name): NICOLE ALYSSA HLEBEC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/09/2019
Last Update Date: 05/01/2025
Certification Date: 05/01/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

510 WICKSTONE PL
ALPHARETTA GA
30004-0935
US

IV. Provider business mailing address

510 WICKSTONE PL
ALPHARETTA GA
30004-0935
US

V. Phone/Fax

Practice location:
  • Phone: 678-451-9164
  • Fax:
Mailing address:
  • Phone: 678-451-9164
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberCHIR011393
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: