Provider Demographics
NPI:1154510519
Name:EXCEL FAMILY CHIROPRACTIC & WELLNESS INC
Entity Type:Organization
Organization Name:EXCEL FAMILY CHIROPRACTIC & WELLNESS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DONNA
Authorized Official - Middle Name:J
Authorized Official - Last Name:BROWN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:262-248-6700
Mailing Address - Street 1:820 GENEVA PKWY N UNIT 105
Mailing Address - Street 2:
Mailing Address - City:LAKE GENEVA
Mailing Address - State:WI
Mailing Address - Zip Code:53147-4562
Mailing Address - Country:US
Mailing Address - Phone:262-248-6700
Mailing Address - Fax:262-248-6764
Practice Address - Street 1:820 GENEVA PKWY N UNIT 105
Practice Address - Street 2:
Practice Address - City:LAKE GENEVA
Practice Address - State:WI
Practice Address - Zip Code:53147-4562
Practice Address - Country:US
Practice Address - Phone:262-248-6700
Practice Address - Fax:262-248-6764
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-22
Last Update Date:2023-07-17
Deactivation Date:2008-06-03
Deactivation Code:
Reactivation Date:2008-07-21
Provider Licenses
StateLicense IDTaxonomies
WI2243012111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI000035563OtherMEDICARE GROUP