Provider Demographics
NPI:1700554714
Name:RESTORE FAMILY CHIROPRACTIC, INC
Entity Type:Organization
Organization Name:RESTORE FAMILY CHIROPRACTIC, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KRISTIN
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:WAHL
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:715-861-3174
Mailing Address - Street 1:331 E PRAIRIE VIEW RD
Mailing Address - Street 2:
Mailing Address - City:CHIPPEWA FALLS
Mailing Address - State:WI
Mailing Address - Zip Code:54729-3463
Mailing Address - Country:US
Mailing Address - Phone:715-861-3174
Mailing Address - Fax:715-861-5000
Practice Address - Street 1:331 E PRAIRIE VIEW RD
Practice Address - Street 2:
Practice Address - City:CHIPPEWA FALLS
Practice Address - State:WI
Practice Address - Zip Code:54729-3463
Practice Address - Country:US
Practice Address - Phone:715-861-3174
Practice Address - Fax:715-861-5000
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-09-03
Last Update Date:2021-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty