Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111N00000X | Chiropractor | 038.012057 | IL |
NPI | 1003183336 |
---|---|
Provider Name | Mrs. Nikole Lee Hunter |
First Address | Glen Carbon, IL 62034-1638 |
Second Address | Glen Carbon, IL 62034 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/12/2011 |
Last Update Date | 31/08/2018 |