Organization
ELLSWORTH CHIROPRACTIC INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. GAYLE A NISSEN DC (PRESIDENT/OWNER)
(715) 273-4115
Entity
Organization
Contact information
Practice address
187 E MAIN ST, ELLSWORTH, WI 54011
(715) 273-4115
Mailing address
187 E MAIN ST, PO BOX 668, ELLSWORTH, WI 54011
(715) 273-4115
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
Primary
2462
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
64362EL
BLUE CROSS BLUE SHIELD
MN
Enumeration date
01/10/2008
Last updated
04/20/2009
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