Provider Demographics
NPI:1073292223
Name:DRIFTLESS ONE CHIROPRACTIC, INC.
Entity Type:Organization
Organization Name:DRIFTLESS ONE CHIROPRACTIC, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINIC DIRECTOR/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KRISTOPHER
Authorized Official - Middle Name:SHANE
Authorized Official - Last Name:NORDRUM
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:630-542-1659
Mailing Address - Street 1:120 SUNSET RIDGE AVE STE 109
Mailing Address - Street 2:
Mailing Address - City:GAYS MILLS
Mailing Address - State:WI
Mailing Address - Zip Code:54631-8331
Mailing Address - Country:US
Mailing Address - Phone:630-542-1659
Mailing Address - Fax:
Practice Address - Street 1:120 SUNSET RIDGE AVE STE 109
Practice Address - Street 2:
Practice Address - City:GAYS MILLS
Practice Address - State:WI
Practice Address - Zip Code:54631-8331
Practice Address - Country:US
Practice Address - Phone:630-542-1659
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-07-14
Last Update Date:2023-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty