Provider Demographics
NPI:1134301435
Name:HJELLE CHIROPRACTIC CLINIC, S.C.
Entity Type:Organization
Organization Name:HJELLE CHIROPRACTIC CLINIC, S.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:ANTHONY
Authorized Official - Middle Name:D
Authorized Official - Last Name:HJELLE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:715-362-6501
Mailing Address - Street 1:201 E ANDERSON ST
Mailing Address - Street 2:
Mailing Address - City:RHINELANDER
Mailing Address - State:WI
Mailing Address - Zip Code:54501-3771
Mailing Address - Country:US
Mailing Address - Phone:715-362-6501
Mailing Address - Fax:715-362-6502
Practice Address - Street 1:201 E ANDERSON ST
Practice Address - Street 2:
Practice Address - City:RHINELANDER
Practice Address - State:WI
Practice Address - Zip Code:54501-3771
Practice Address - Country:US
Practice Address - Phone:715-362-6501
Practice Address - Fax:715-362-6502
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-29
Last Update Date:2013-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI111N00000X261QH0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI38909600Medicaid
WI000035453Medicare PIN
WIU73591Medicare UPIN
WI000075198Medicare PIN