Provider Demographics
NPI:1093116980
Name:OUELLETTE, NICHOLAS OUIMET (DC)
Entity type:Individual
Prefix:DR
First Name:NICHOLAS
Middle Name:OUIMET
Last Name:OUELLETTE
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4 BARTLETT RD
Mailing Address - Street 2:
Mailing Address - City:NANTUCKET
Mailing Address - State:MA
Mailing Address - Zip Code:02554-4381
Mailing Address - Country:US
Mailing Address - Phone:508-325-4777
Mailing Address - Fax:508-228-7024
Practice Address - Street 1:4 BARTLETT RD
Practice Address - Street 2:
Practice Address - City:NANTUCKET
Practice Address - State:MA
Practice Address - Zip Code:02554-4381
Practice Address - Country:US
Practice Address - Phone:508-325-4777
Practice Address - Fax:508-228-7024
Is Sole Proprietor?:No
Enumeration Date:2014-09-10
Last Update Date:2016-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MACH-3470111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor