Organization
DETERT CHIROPRACTIC OFFICE SC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. LAURA LEANNE DETERT DC (PRESIDENT CHIROPRACTOR)
(715) 754-2555
Entity
Organization
Contact information
Practice address
1101 N MAIN ST, MARION, WI 54950-9182
(715) 754-2555
(715) 754-2559
Mailing address
PO BOX 485, MARION, WI 54950-0485
(715) 754-2555
(715) 754-2559
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
Primary
2895-012
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
LAURA38866500
—
WI
05
—
OFF38984900
—
WI
Enumeration date
07/29/2005
Last updated
07/09/2010
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