Organization
SHELL LAKE CUMBERLAND CHIROPRACTIC CLINICS LLC
Active
Other names
Jimmy A Reidt
Organization subpart
No
Provider details
NPI number
Authorized official
BRENDA REIDT DC (MANAGER)
(715) 468-2275
Entity
Organization
Contact information
Practice address
17 5TH AVE, SHELL LAKE, WI 54871
(715) 468-2275
Mailing address
PO BOX 637, SHELL LAKE, WI 54871
(715) 468-2275
(715) 468-4417
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
Primary
3069
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
70330
MEDICARE GROUP NUMBER
—
Enumeration date
10/04/2007
Last updated
01/13/2021
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