Healthcare Provider Details

I. General information

NPI: 1962604702
Provider Name (Legal Business Name): FLESCH CHIROPRACTIC LTD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/04/2007
Last Update Date: 04/04/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

29 W. MAIN ST.
BELLEVILLE WI
53508
US

IV. Provider business mailing address

PO BOX 235
BELLEVILLE WI
53508-0235
US

V. Phone/Fax

Practice location:
  • Phone: 608-424-6525
  • Fax:
Mailing address:
  • Phone: 608-424-6525
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number3017-012
License Number StateWI

VIII. Authorized Official

Name: EDWARD V FLESCH
Title or Position: CEO
Credential: D.C.
Phone: 608-424-6525