Healthcare Provider Details

I. General information

NPI: 1972841278
Provider Name (Legal Business Name): NICOLE DUCHARME D.C.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/21/2013
Last Update Date: 01/21/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4866 CARYA RD
BLACK EARTH WI
53515-9508
US

IV. Provider business mailing address

4866 CARYA RD
BLACK EARTH WI
53515-9508
US

V. Phone/Fax

Practice location:
  • Phone: 608-513-3530
  • Fax:
Mailing address:
  • Phone: 608-513-3530
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number4913-12
License Number StateWI
# 2
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number3403
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: