Organization
CHIROPRACTIC ASSOCIATESS OF KENOSHA A S C
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. MICHAEL TRABBOLD D.C., CCSP (OWNER/PRESIDENT)
(262) 942-9955
Entity
Organization
Contact information
Practice address
3120 80TH ST, KENOSHA, WI 53142-4946
(262) 942-9955
(262) 942-9958
Mailing address
3120 80TH ST, KENOSHA, WI 53142-4946
(262) 942-9955
(262) 942-9958
Taxonomy
Speciality
Code
Description
License number
State
261Q00000X
Clinic/Center
Primary
3665
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
38928300
—
WI
Enumeration date
12/29/2010
Last updated
03/24/2011
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