Healthcare Provider Details

I. General information

NPI: 1265481709
Provider Name (Legal Business Name): STEPHANNIE DAWN GILKEY-NICOL D.C.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/10/2006
Last Update Date: 03/20/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

412 PENNSYLVANIA AVE
HOLTON KS
66436-1803
US

IV. Provider business mailing address

412 PENNSYLVANIA AVE
HOLTON KS
66436-1803
US

V. Phone/Fax

Practice location:
  • Phone: 785-364-9003
  • Fax: 785-364-9006
Mailing address:
  • Phone: 785-364-9003
  • Fax: 785-364-9006

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number01-04759
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: