Provider Demographics
NPI:1588496996
Name:BUMP AND BEYOND FAMILY WELLNESS LLC
Entity type:Organization
Organization Name:BUMP AND BEYOND FAMILY WELLNESS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:NADINE
Authorized Official - Middle Name:M
Authorized Official - Last Name:ILLICHMANN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:920-298-8307
Mailing Address - Street 1:2848 MEMORIAL DR STE 9
Mailing Address - Street 2:
Mailing Address - City:TWO RIVERS
Mailing Address - State:WI
Mailing Address - Zip Code:54241-3639
Mailing Address - Country:US
Mailing Address - Phone:920-304-9374
Mailing Address - Fax:
Practice Address - Street 1:2848 MEMORIAL DR STE 9
Practice Address - Street 2:
Practice Address - City:TWO RIVERS
Practice Address - State:WI
Practice Address - Zip Code:54241-3639
Practice Address - Country:US
Practice Address - Phone:920-304-9374
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-08-14
Last Update Date:2024-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty