Provider Demographics
NPI:1154788792
Name:SANDIDGE, NICOLE (DC)
Entity type:Individual
Prefix:DR
First Name:NICOLE
Middle Name:
Last Name:SANDIDGE
Suffix:
Gender:F
Credentials:DC
Other - Prefix:DR
Other - First Name:NICOLE
Other - Middle Name:
Other - Last Name:RICHARDS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DC
Mailing Address - Street 1:12920 LEBANON RD
Mailing Address - Street 2:STE 1
Mailing Address - City:MT JULIET
Mailing Address - State:TN
Mailing Address - Zip Code:37122-2865
Mailing Address - Country:US
Mailing Address - Phone:615-758-7373
Mailing Address - Fax:615-827-0010
Practice Address - Street 1:12920 LEBANON RD
Practice Address - Street 2:STE 1
Practice Address - City:MT JULIET
Practice Address - State:TN
Practice Address - Zip Code:37122-2865
Practice Address - Country:US
Practice Address - Phone:615-758-7373
Practice Address - Fax:615-827-0010
Is Sole Proprietor?:No
Enumeration Date:2016-01-27
Last Update Date:2022-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC011100111N00000X
TN2999111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor