Provider Demographics
NPI:1871766865
Name:SICBLE, COTY R (DC)
Entity type:Individual
Prefix:
First Name:COTY
Middle Name:R
Last Name:SICBLE
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:COTY
Other - Middle Name:R
Other - Last Name:HAGER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DC
Mailing Address - Street 1:1921 N 13TH ST
Mailing Address - Street 2:
Mailing Address - City:BISMARCK
Mailing Address - State:ND
Mailing Address - Zip Code:58501-1973
Mailing Address - Country:US
Mailing Address - Phone:701-222-2252
Mailing Address - Fax:701-222-3645
Practice Address - Street 1:1921 N 13TH ST
Practice Address - Street 2:
Practice Address - City:BISMARCK
Practice Address - State:ND
Practice Address - Zip Code:58501-1973
Practice Address - Country:US
Practice Address - Phone:701-222-2252
Practice Address - Fax:701-222-3645
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-10
Last Update Date:2008-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND813111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor