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General NPI Number Information
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NPI Number | 1164200721
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Entity Type | Organization
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Legal Business Name | PIVOTAL HEALTH CHIROPRACTIC LLC
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Dates
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Enumeration Date | 09/15/2023
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Last Update Date | 09/15/2023
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Provider Practice Location Address
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Address Line | 1500 MADISON AVE STE 205
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City | NEW RICHMOND
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State | WI
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Zip | 54017-6693
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Country | US
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Telephone | 715-204-4223
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Fax |
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Provider Business Mailing Address
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Address Line | 801 W 8TH ST APT 207
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City | NEW RICHMOND
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State | WI
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Zip | 54017-5600
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Country | US
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Telephone | 605-323-7310
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Fax |
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Authorized Official
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Title or Position | OWNER/CHIROPRACTOR
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Name | DR. KYLIE MISHAY CRESS
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Credential | DC
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Telephone | 715-204-4223
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number |
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License Number State |
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