MEDICARE: DR. NICOLE CHRISTINE GAITANIS-IOLI 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	7159	AZ

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	AZ0943220	OTHER	AZ	BCBS

General Provider Information

NPI Number	:	1538209275
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. NICOLE CHRISTINE GAITANIS-IOLI D.C.

Provider Business Mailing Address
First Line	:	3959 E LAMBETH PL
Second Line	:
City	:	QUEEN CREEK
State	:	AZ
Zip	:	85140-5126
Country	:	US
Telephone Number	:	480-205-6951
Fax Number	:

Provider Business Practice Location Address
First Line	:	21321 E OCOTILLO RD
Second Line	:	B105 ROOM 10
City	:	QUEEN CREEK
State	:	AZ
Zip	:	85142-5996
Country	:	US
Telephone Number	:	480-205-6951
Fax Number	:

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

Provider Enumeration Date	:	02/08/2007
Last Update Date	:	07/23/2012

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