Provider Demographics
NPI:1447097159
Name:COLSON, NICOLE LEA (DC)
Entity type:Individual
Prefix:DR
First Name:NICOLE
Middle Name:LEA
Last Name:COLSON
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 1:104 MAIN STREET
Mailing Address - Street 2:PO BOX 242
Mailing Address - City:BLUE HILL
Mailing Address - State:ME
Mailing Address - Zip Code:04614
Mailing Address - Country:US
Mailing Address - Phone:813-380-2405
Mailing Address - Fax:
Practice Address - Street 1:20 E BLUE HILL RD
Practice Address - Street 2:
Practice Address - City:BLUE HILL
Practice Address - State:ME
Practice Address - Zip Code:04614-5312
Practice Address - Country:US
Practice Address - Phone:207-374-2186
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-10
Last Update Date:2024-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MECR3016111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty