Provider Demographics
NPI:1104416585
Name:WAKULLA CHIROPRACTIC & ACUPUNCTURE
Entity type:Organization
Organization Name:WAKULLA CHIROPRACTIC & ACUPUNCTURE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER AND CHIROPRACTIC
Authorized Official - Prefix:
Authorized Official - First Name:BRIANNE
Authorized Official - Middle Name:KERRY
Authorized Official - Last Name:SCHROEDER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:518-929-0707
Mailing Address - Street 1:3605 CAGNEY DR
Mailing Address - Street 2:
Mailing Address - City:TALLAHASSEE
Mailing Address - State:FL
Mailing Address - Zip Code:32309-3341
Mailing Address - Country:US
Mailing Address - Phone:518-929-0707
Mailing Address - Fax:
Practice Address - Street 1:27 AZALEA DR UNIT C
Practice Address - Street 2:
Practice Address - City:CRAWFORDVILLE
Practice Address - State:FL
Practice Address - Zip Code:32327-8033
Practice Address - Country:US
Practice Address - Phone:518-929-0707
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-01-20
Last Update Date:2021-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty