Provider Demographics
NPI:1447620950
Name:KLERSY-MOHR, NICOLE (DC, CFMP)
Entity type:Individual
Prefix:DR
First Name:NICOLE
Middle Name:
Last Name:KLERSY-MOHR
Suffix:
Gender:F
Credentials:DC, CFMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:27312 GASPARILLA DR
Mailing Address - Street 2:
Mailing Address - City:BONITA SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:34135-4309
Mailing Address - Country:US
Mailing Address - Phone:763-913-5978
Mailing Address - Fax:
Practice Address - Street 1:9990 COCONUT RD # 248
Practice Address - Street 2:
Practice Address - City:ESTERO
Practice Address - State:FL
Practice Address - Zip Code:34135-8488
Practice Address - Country:US
Practice Address - Phone:763-913-5978
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-09-28
Last Update Date:2024-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN6117111N00000X
MN225700000X
FL225700000X
FLCH14947111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
No225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist