Provider Demographics
NPI:1982829735
Name:BELVILLE FLETCHER CHIROPRACTIC OFFICE SC
Entity Type:Organization
Organization Name:BELVILLE FLETCHER CHIROPRACTIC OFFICE SC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:KENT
Authorized Official - Middle Name:L
Authorized Official - Last Name:BELVILLE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:920-233-2828
Mailing Address - Street 1:PO BOX 2525
Mailing Address - Street 2:
Mailing Address - City:OSHKOSH
Mailing Address - State:WI
Mailing Address - Zip Code:54903-2525
Mailing Address - Country:US
Mailing Address - Phone:920-233-2828
Mailing Address - Fax:920-232-2928
Practice Address - Street 1:440 N KOELLER ST
Practice Address - Street 2:
Practice Address - City:OSHKOSH
Practice Address - State:WI
Practice Address - Zip Code:54902-4111
Practice Address - Country:US
Practice Address - Phone:920-233-2828
Practice Address - Fax:920-232-2829
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-16
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI38888100Medicaid
WI70420Medicare ID - Type Unspecified
WI38888100Medicaid