Organization
ACTIVE CHIROPRACTIC LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JACQUELYN MICHELE RUSSELL DC (CHIROPRACTIC ASSISTANT)
(715) 568-9923
Entity
Organization
Contact information
Practice address
1706 YORK ST, SUITE 5, BLOOMER, WI 54724-1920
(715) 568-9923
(715) 568-9924
Mailing address
1706 YORK ST, SUITE 5, BLOOMER, WI 54724-1920
(715) 568-9923
(715) 568-9924
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
Primary
4151-012
WI
Other
Enumeration date
05/13/2008
Last updated
06/04/2008
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