Provider Demographics
NPI:1922471432
Name:MOSINEE FAMILY CHIROPRACTIC SC
Entity Type:Organization
Organization Name:MOSINEE FAMILY CHIROPRACTIC SC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:KELLY
Authorized Official - Middle Name:ALIDA
Authorized Official - Last Name:SACKMANN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:715-693-4144
Mailing Address - Street 1:107 MAPLE ST
Mailing Address - Street 2:
Mailing Address - City:MOSINEE
Mailing Address - State:WI
Mailing Address - Zip Code:54455-1924
Mailing Address - Country:US
Mailing Address - Phone:715-693-4144
Mailing Address - Fax:
Practice Address - Street 1:107 MAPLE ST
Practice Address - Street 2:
Practice Address - City:MOSINEE
Practice Address - State:WI
Practice Address - Zip Code:54455-1924
Practice Address - Country:US
Practice Address - Phone:715-693-4144
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-11-05
Last Update Date:2019-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1418-012111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty