Provider Demographics
NPI:1730447707
Name:ABEGGLEN CHIROPRACTIC CLINIC SERVICE CORPORATION
Entity type:Organization
Organization Name:ABEGGLEN CHIROPRACTIC CLINIC SERVICE CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DENNIS
Authorized Official - Middle Name:A
Authorized Official - Last Name:ABEGGLEN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:715-536-5451
Mailing Address - Street 1:925 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:MERRILL
Mailing Address - State:WI
Mailing Address - Zip Code:54452-2502
Mailing Address - Country:US
Mailing Address - Phone:715-536-5451
Mailing Address - Fax:715-536-4945
Practice Address - Street 1:925 E MAIN ST
Practice Address - Street 2:
Practice Address - City:MERRILL
Practice Address - State:WI
Practice Address - Zip Code:54452-2502
Practice Address - Country:US
Practice Address - Phone:715-536-5451
Practice Address - Fax:715-536-4945
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-04-27
Last Update Date:2012-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2005111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty