Provider Demographics
NPI:1497513816
Name:ROBILLARD CHIROPRACTIC LLC
Entity Type:Organization
Organization Name:ROBILLARD CHIROPRACTIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RYAN
Authorized Official - Middle Name:
Authorized Official - Last Name:ROBILLARD
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:920-851-5505
Mailing Address - Street 1:N167W21251 SOUTH ST
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:WI
Mailing Address - Zip Code:53037-9315
Mailing Address - Country:US
Mailing Address - Phone:920-851-5505
Mailing Address - Fax:
Practice Address - Street 1:1221 E NORTHLAND AVE
Practice Address - Street 2:
Practice Address - City:APPLETON
Practice Address - State:WI
Practice Address - Zip Code:54911-8415
Practice Address - Country:US
Practice Address - Phone:920-954-1002
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-03-11
Last Update Date:2024-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty