Provider Demographics
NPI:1457774549
Name:TELL PECK, MICHELLE (DC)
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:
Last Name:TELL PECK
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:MICHELLE
Other - Middle Name:
Other - Last Name:TELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DC
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:715-723-3333
Is Sole Proprietor?:Yes
Enumeration Date:2014-01-27
Last Update Date:2023-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI4991-12111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor