Provider Demographics
NPI:1427535236
Name:NICOLE BREIVOGEL DC, LLC
Entity type:Organization
Organization Name:NICOLE BREIVOGEL DC, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:NICOLE
Authorized Official - Middle Name:E
Authorized Official - Last Name:BREIVOGEL
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:413-262-4730
Mailing Address - Street 1:681 FALMOUTH RD STE B21
Mailing Address - Street 2:
Mailing Address - City:MASHPEE
Mailing Address - State:MA
Mailing Address - Zip Code:02649-6312
Mailing Address - Country:US
Mailing Address - Phone:413-262-4730
Mailing Address - Fax:508-528-0654
Practice Address - Street 1:681 FALMOUTH RD STE B21
Practice Address - Street 2:
Practice Address - City:MASHPEE
Practice Address - State:MA
Practice Address - Zip Code:02649-6312
Practice Address - Country:US
Practice Address - Phone:413-262-4730
Practice Address - Fax:508-528-0654
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-07-24
Last Update Date:2020-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA3504111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty