Active Chiropractic LLC

NPI #1780851279 in Bloomer, Wisconsin

Provider Information

NPI Number: 1780851279
Entity Type: Organization
Organization Name: Active Chiropractic LLC
Primary Specialty: Chiropractor
Enumeration Date: May 13, 2008
Last Updated: Jun 4, 2008

Practice Location

Address: 1706 YORK ST
Address 2: SUITE 5
City: Bloomer
State: Wisconsin
ZIP Code: 54724-1920
Phone: (715) 568-9923

Authorized Official

Name: JACQUELYN MICHELE RUSSELL, DC
Title: CHIROPRACTIC ASSISTANT
Phone: (715) 568-9923

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Chiropractor	111N00000X	Primary

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