Individual
NICOLE WILLIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
D.C.
Contact information
Practice address
1570 E HERITAGE PARK ST, STE 175, MERIDIAN, ID 83646-6445
(208) 322-4114
(208) 322-4115
Mailing address
1570 E HERITAGE PARK ST, STE 175, MERIDIAN, ID 83646-6445
(208) 322-4114
(208) 322-4115
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
Primary
CHIA-1268
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1370103
GROUP PTAN
—
Enumeration date
01/28/2008
Last updated
01/31/2020
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