Organization
WINNECONNE CHIROPRACTIC AND SPORTS REHAB LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. ALEXANDRA GRACE KELLOGG D.C (OWNER)
(920) 915-4210
Entity
Organization
Contact information
Practice address
238 W MAIN STREET, WINNECONNE, WI 54986
(920) 706-0178
(920) 706-0179
Mailing address
PO BOX 365, WINNECONNE, WI 54986-0365
(920) 706-0178
(920) 706-0179
Taxonomy
Speciality
Code
Description
License number
State
111NS0005X
Sports Physician Chiropractor
Primary
4667-012
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1619278819
—
WI
Enumeration date
07/28/2014
Last updated
10/14/2014
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