MEDICARE: CHIROPRACTIC CLINIC SC

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	1567-012	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	:	1346244001
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CHIROPRACTIC CLINIC SC

Provider Business Mailing Address
First Line	:	1219 MAIN ST W
Second Line	:
City	:	ASHLAND
State	:	WI
Zip	:	54806-1202
Country	:	US
Telephone Number	:	715-682-4033
Fax Number	:	715-682-4033

Provider Business Practice Location Address
First Line	:	1219 MAIN ST W
Second Line	:
City	:	ASHLAND
State	:	WI
Zip	:	54806-1202
Country	:	US
Telephone Number	:	715-682-4033
Fax Number	:	715-682-4033

Authorized Official
Title or Position	:	DOCTOR/OWNER
Name	:	RICHARD GLESSING
Credential	:	D.C.
Telephone Number	:	715-682-4033

Provider Enumeration Date	:	06/10/2005
Last Update Date	:	01/04/2019

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Directions to “CHIROPRACTIC CLINIC SC ” Practice Location

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