Provider Demographics
NPI:1487453239
Name:RESTORE CHIROPRACTIC AND WELLNESS
Entity type:Organization
Organization Name:RESTORE CHIROPRACTIC AND WELLNESS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/CHIROPRACTOR
Authorized Official - Prefix:
Authorized Official - First Name:MIRANDA
Authorized Official - Middle Name:LORELEI
Authorized Official - Last Name:FISK
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:402-518-1444
Mailing Address - Street 1:711 3RD ST
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:MN
Mailing Address - Zip Code:56143-1614
Mailing Address - Country:US
Mailing Address - Phone:402-518-1444
Mailing Address - Fax:
Practice Address - Street 1:711 3RD ST
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:MN
Practice Address - Zip Code:56143-1614
Practice Address - Country:US
Practice Address - Phone:402-518-1444
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-03-12
Last Update Date:2025-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty