Individual
DR. GAYLE ANN NISSEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DC
Contact information
Practice address
187 E MAIN ST, ELLSWORTH, WI 54011
(715) 273-5290
Mailing address
PO BOX 668, ELLSWORTH, WI 54011-0668
(715) 273-5290
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
Primary
2462
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
392040911010
BCBS
WI
01
—
411508205
HEALTH SERVICES MGMT
MN
01
—
64363NI
BLUECROSS BLUE SHIELD OF MN
MN
Enumeration date
10/31/2006
Last updated
04/20/2009
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