Individual
NICOLE SUZANNE DEBROUX
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DC
Contact information
Practice address
2006 PROGRESS BLVD, ANTIGO, WI 54409
(715) 623-5481
(715) 627-0177
Mailing address
2006 PROGRESS BLVD, ANTIGO, WI 54409
(715) 623-5481
(715) 627-0177
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
Primary
3545012
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
58113
SECURITY HEALTH PLAN
WI
Enumeration date
10/23/2006
Last updated
07/08/2007
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