Provider Demographics
NPI:1871049692
Name:GIACOPELLI, NICOLE THERESA (DC)
Entity type:Individual
Prefix:DR
First Name:NICOLE
Middle Name:THERESA
Last Name:GIACOPELLI
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 1:930 PYOTT RD
Mailing Address - Street 2:STE 102
Mailing Address - City:CRYSTAL LAKE
Mailing Address - State:IL
Mailing Address - Zip Code:60014-8721
Mailing Address - Country:US
Mailing Address - Phone:815-890-6815
Mailing Address - Fax:815-893-6958
Practice Address - Street 1:6000 E STATE ST STE 201
Practice Address - Street 2:
Practice Address - City:ROCKFORD
Practice Address - State:IL
Practice Address - Zip Code:61108-2521
Practice Address - Country:US
Practice Address - Phone:815-828-6007
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-08-31
Last Update Date:2020-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038.012997111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor