MEDICARE: DR. NICOLE JEAN STOESSEL DC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor	F1-0000508	DE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	51-0256713	OTHER	DE	BLUE CROSS
2	3713761	OTHER	CT	AETNA

General Provider Information

NPI Number	:	1013916303
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. NICOLE JEAN STOESSEL DC

Provider Business Mailing Address
First Line	:	2600 GLASGOW AVE STE 124
Second Line	:
City	:	NEWARK
State	:	DE
Zip	:	19702-4777
Country	:	US
Telephone Number	:	302-256-8622
Fax Number	:	302-340-7444

Provider Business Practice Location Address
First Line	:	2207 CONCORD PIKE # 207
Second Line	:
City	:	WILMINGTON
State	:	DE
Zip	:	19803-2908
Country	:	US
Telephone Number	:	302-256-8622
Fax Number	:	302-340-7444

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/19/2005
Last Update Date	:	04/03/2014

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