Provider Demographics
NPI:1366914046
Name:SEDLACEK, NICOLE ANN (DC)
Entity type:Individual
Prefix:
First Name:NICOLE
Middle Name:ANN
Last Name:SEDLACEK
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:745 COMMUNITY DR UNIT D
Mailing Address - Street 2:
Mailing Address - City:NORTH LIBERTY
Mailing Address - State:IA
Mailing Address - Zip Code:52317-6709
Mailing Address - Country:US
Mailing Address - Phone:319-665-9595
Mailing Address - Fax:
Practice Address - Street 1:745 COMMUNITY DR UNIT D
Practice Address - Street 2:
Practice Address - City:NORTH LIBERTY
Practice Address - State:IA
Practice Address - Zip Code:52317-6709
Practice Address - Country:US
Practice Address - Phone:319-665-9595
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-12-19
Last Update Date:2018-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA093604111NP0017X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NP0017XChiropractic ProvidersChiropractorPediatric Chiropractor