Provider Demographics
NPI:1144607946
Name:TELL PECK CHIROPRACTIC INC
Entity Type:Organization
Organization Name:TELL PECK CHIROPRACTIC INC
Other - Org Name:WISSOTA CHIROPRACTIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIROPRACTOR/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:
Authorized Official - Last Name:TELL PECK
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:715-723-3333
Mailing Address - Street 1:17191 COUNTY HIGHWAY X
Mailing Address - Street 2:
Mailing Address - City:CHIPPEWA FALLS
Mailing Address - State:WI
Mailing Address - Zip Code:54729-8057
Mailing Address - Country:US
Mailing Address - Phone:715-723-3333
Mailing Address - Fax:715-723-3309
Practice Address - Street 1:17191 COUNTY HIGHWAY X
Practice Address - Street 2:
Practice Address - City:CHIPPEWA FALLS
Practice Address - State:WI
Practice Address - Zip Code:54729-8057
Practice Address - Country:US
Practice Address - Phone:715-723-3333
Practice Address - Fax:715-723-3309
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-04-30
Last Update Date:2015-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI4991-12111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty