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Organization
RUSSELL CHIROPRACTIC LLC
Active
Organization
RUSSELL CHIROPRACTIC LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JACQUELYN M RUSSELL DC (OWNER)
(715) 239-0909
Entity
Organization
Contact information
Practice address
425 BRIDGE ST, CORNELL, WI 54732-8391
(715) 239-0909
(715) 239-0908
Mailing address
425 BRIDGE ST, CORNELL, WI 54732-8391
(715) 239-0909
(715) 239-0908
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
Primary
4384012
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
38183500
—
WI
Enumeration date
02/25/2011
Last updated
02/25/2011
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