Provider Demographics
NPI:1740489228
Name:GOSSE CHIROPRACTIC LLC
Entity type:Organization
Organization Name:GOSSE CHIROPRACTIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CLINT
Authorized Official - Middle Name:JASON
Authorized Official - Last Name:GOSSE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:715-659-4411
Mailing Address - Street 1:702C EAST WILLOW DRIVE
Mailing Address - Street 2:
Mailing Address - City:SPENCER
Mailing Address - State:WI
Mailing Address - Zip Code:54479-9344
Mailing Address - Country:US
Mailing Address - Phone:715-659-4411
Mailing Address - Fax:715-659-4414
Practice Address - Street 1:702C EAST WILLOW DRIVE
Practice Address - Street 2:
Practice Address - City:SPENCER
Practice Address - State:WI
Practice Address - Zip Code:54479-9344
Practice Address - Country:US
Practice Address - Phone:715-659-4411
Practice Address - Fax:715-659-4414
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-13
Last Update Date:2007-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI4321012111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty