MEDICARE: MRS. NICOLE MARIE FAUSEY-LUKE D.C.

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	2301009391	MI

General Provider Information

NPI Number	:	1528249471
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. NICOLE MARIE FAUSEY-LUKE D.C.

Provider Business Mailing Address
First Line	:	170 NORTH AVE
Second Line	:
City	:	BATTLE CREEK
State	:	MI
Zip	:	49017-3419
Country	:	US
Telephone Number	:	269-963-8249
Fax Number	:	269-963-0550

Provider Business Practice Location Address
First Line	:	170 NORTH AVE
Second Line	:
City	:	BATTLE CREEK
State	:	MI
Zip	:	49017-3419
Country	:	US
Telephone Number	:	269-963-8249
Fax Number	:	269-963-0550

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

Provider Enumeration Date	:	11/20/2007
Last Update Date	:	11/20/2007

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