Provider Demographics
NPI:1326554056
Name:PORTEUS, NICHOLE (DC)
Entity type:Individual
Prefix:DR
First Name:NICHOLE
Middle Name:
Last Name:PORTEUS
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:425 E LAMAR BLVD
Mailing Address - Street 2:APT 167
Mailing Address - City:ARLINGTON
Mailing Address - State:TX
Mailing Address - Zip Code:76011
Mailing Address - Country:US
Mailing Address - Phone:303-875-7195
Mailing Address - Fax:
Practice Address - Street 1:771 E SOUTHLAKE BLVD STE 103
Practice Address - Street 2:
Practice Address - City:SOUTHLAKE
Practice Address - State:TX
Practice Address - Zip Code:76092-6354
Practice Address - Country:US
Practice Address - Phone:469-369-7958
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-12-18
Last Update Date:2020-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX12531111NP0017X, 111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
No111NP0017XChiropractic ProvidersChiropractorPediatric Chiropractor