Individual
KELLEN BLANCK-GROTT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.C.
Contact information
Practice address
709 DYER ST, CRIVITZ, WI 54114
(715) 854-5025
Mailing address
709 DYER ST, CRIVITZ, WI 54114-7480
(715) 854-5025
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
Primary
5160-12
WI
Other
Enumeration date
04/05/2016
Last updated
07/12/2018
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