Provider Demographics
NPI:1861799975
Name:NORTH COUNTRY CHIROPRACTIC & WELLNESS LLC
Entity type:Organization
Organization Name:NORTH COUNTRY CHIROPRACTIC & WELLNESS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:VIJAI
Authorized Official - Middle Name:
Authorized Official - Last Name:KHAN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:715-358-6650
Mailing Address - Street 1:PO BOX 2195
Mailing Address - Street 2:
Mailing Address - City:WOODRUFF
Mailing Address - State:WI
Mailing Address - Zip Code:54568-2195
Mailing Address - Country:US
Mailing Address - Phone:715-358-6650
Mailing Address - Fax:715-358-6381
Practice Address - Street 1:521 HEMLOCK ST
Practice Address - Street 2:
Practice Address - City:WOODRUFF
Practice Address - State:WI
Practice Address - Zip Code:54568-9197
Practice Address - Country:US
Practice Address - Phone:715-358-6650
Practice Address - Fax:715-358-6381
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-02-25
Last Update Date:2011-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI4725-12111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty