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Organization
FAMILY CHIROPRACTIC CLINIC INC
Active
Organization
FAMILY CHIROPRACTIC CLINIC INC
Active
Other names
MADISON CHIROPRACTIC NORTH
Organization subpart
No
Provider details
NPI number
Authorized official
DR. BRENT MCNABB DC (CHIROPRACTOR)
(608) 244-0044
Entity
Organization
Contact information
Practice address
2205 N SHERMAN AVE, MADISON, WI 53704-3310
(608) 244-0044
Mailing address
2205 N SHERMAN AVE, MADISON, WI 53704-3310
(608) 244-0044
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
Primary
1579
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1083686737
ROSS ROYSTER NPI
WI
01
—
1346212099
DANIEL SODERHOLM NPI
WI
01
—
1356313001
BRENT MCNABB NPI
WI
01
—
1579
BRENT MCNABB LICENSE
WI
01
—
1619
ROSS ROYSTER LICENSE
WI
01
—
1692
DANIEL SODERHOLM LICENSE
WI
05
—
38767300
—
WI
05
—
38767400
—
WI
05
—
38777500
—
WI
Enumeration date
04/02/2007
Last updated
11/28/2012
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