Provider Demographics
NPI:1386297760
Name:CHIROPRACTIC HEALTH OF APPLETON, LLC
Entity type:Organization
Organization Name:CHIROPRACTIC HEALTH OF APPLETON, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING
Authorized Official - Prefix:
Authorized Official - First Name:NICOLE
Authorized Official - Middle Name:
Authorized Official - Last Name:IMMEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:920-757-5771
Mailing Address - Street 1:N1724 MUNICIPAL DR
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:WI
Mailing Address - Zip Code:54942-8721
Mailing Address - Country:US
Mailing Address - Phone:920-757-5771
Mailing Address - Fax:920-757-0373
Practice Address - Street 1:3020 E COLLEGE AVE STE H
Practice Address - Street 2:
Practice Address - City:APPLETON
Practice Address - State:WI
Practice Address - Zip Code:54915-3253
Practice Address - Country:US
Practice Address - Phone:920-738-9997
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CHIROPRACTIC HEALTH & REHABILITATION CENTER
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2019-07-24
Last Update Date:2020-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty