Provider Demographics
NPI:1649659525
Name:NUSSLOCK CHIROPRACTIC CORPORATION
Entity type:Organization
Organization Name:NUSSLOCK CHIROPRACTIC CORPORATION
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ANNA
Authorized Official - Middle Name:
Authorized Official - Last Name:NUSSLOCK
Authorized Official - Suffix:
Authorized Official - Credentials:DC CCEP
Authorized Official - Phone:262-389-0105
Mailing Address - Street 1:2332 HARRISON AVE STE C
Mailing Address - Street 2:
Mailing Address - City:EUREKA
Mailing Address - State:CA
Mailing Address - Zip Code:95501-3235
Mailing Address - Country:US
Mailing Address - Phone:707-502-2856
Mailing Address - Fax:
Practice Address - Street 1:2332 HARRISON AVE STE C
Practice Address - Street 2:
Practice Address - City:EUREKA
Practice Address - State:CA
Practice Address - Zip Code:95501-3235
Practice Address - Country:US
Practice Address - Phone:707-502-2856
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-05-25
Last Update Date:2015-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA33263111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty