Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111N00000X | Chiropractor | 12531 | TX |
N | 111NP0017X | Pediatric Chiropractor | 12531 | TX |
NPI | 1326554056 |
---|---|
Provider Name | Dr. Nichole Porteus |
First Address | Arlington, TX 76011 |
Second Address | Southlake, TX 76092-6354 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 18/12/2017 |
Last Update Date | 22/09/2020 |