MEDICARE: CLIFFORD CHIROPRACTIC, INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor		WI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1093071904
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CLIFFORD CHIROPRACTIC, INC.

Provider Business Mailing Address
First Line	:	1957 CTY RD. XX
Second Line	:
City	:	MOSINEE
State	:	WI
Zip	:	54455-9026
Country	:	US
Telephone Number	:	715-355-9009
Fax Number	:	715-355-9109

Provider Business Practice Location Address
First Line	:	1957 CTY RD. XX
Second Line	:
City	:	MOSINEE
State	:	WI
Zip	:	54455-9026
Country	:	US
Telephone Number	:	715-355-9009
Fax Number	:	715-355-9109

Authorized Official
Title or Position	:	OFFICE MANAGER
Name	:	MRS. BECKY LOUISE FLISS
Credential	:
Telephone Number	:	715-355-9009

Provider Enumeration Date	:	04/04/2012
Last Update Date	:	04/04/2012

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Directions to “CLIFFORD CHIROPRACTIC, INC. ” Practice Location

Language	Start Address	Practice Location

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