Provider Demographics
NPI:1992983332
Name:WHEELER-GLOVER, NICOLE LEA
Entity type:Individual
Prefix:
First Name:NICOLE
Middle Name:LEA
Last Name:WHEELER-GLOVER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20 WHITE OAK DR
Mailing Address - Street 2:
Mailing Address - City:WYOMING
Mailing Address - State:RI
Mailing Address - Zip Code:02898-1144
Mailing Address - Country:US
Mailing Address - Phone:401-338-1742
Mailing Address - Fax:
Practice Address - Street 1:20 WHITE OAK DR
Practice Address - Street 2:
Practice Address - City:WYOMING
Practice Address - State:RI
Practice Address - Zip Code:02898-1144
Practice Address - Country:US
Practice Address - Phone:401-338-1742
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-07
Last Update Date:2008-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIDCP00573111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor