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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