Provider Demographics
NPI:1649473380
Name:BELLEVILLE CHIROPRACTIC AND WELLNESS CENTER, S.C.
Entity type:Organization
Organization Name:BELLEVILLE CHIROPRACTIC AND WELLNESS CENTER, S.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:BRAD
Authorized Official - Middle Name:K
Authorized Official - Last Name:FREITAG
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:608-424-1840
Mailing Address - Street 1:1019 RIVER ST
Mailing Address - Street 2:SUITE 5
Mailing Address - City:BELLEVILLE
Mailing Address - State:WI
Mailing Address - Zip Code:53508-9181
Mailing Address - Country:US
Mailing Address - Phone:605-424-1840
Mailing Address - Fax:
Practice Address - Street 1:1019 RIVER ST
Practice Address - Street 2:SUITE 5
Practice Address - City:BELLEVILLE
Practice Address - State:WI
Practice Address - Zip Code:53508-9181
Practice Address - Country:US
Practice Address - Phone:605-424-1840
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-08
Last Update Date:2010-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI3786-012111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty