Provider Demographics
NPI:1780072686
Name:JURGENSEN CHIROPRACTIC OF MONDOVI, INC.
Entity type:Organization
Organization Name:JURGENSEN CHIROPRACTIC OF MONDOVI, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JACOB
Authorized Official - Middle Name:
Authorized Official - Last Name:JURGENSEN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:715-926-4998
Mailing Address - Street 1:143 N FRANKLIN ST
Mailing Address - Street 2:
Mailing Address - City:MONDOVI
Mailing Address - State:WI
Mailing Address - Zip Code:54755-1117
Mailing Address - Country:US
Mailing Address - Phone:715-926-4998
Mailing Address - Fax:715-926-4998
Practice Address - Street 1:143 N FRANKLIN ST
Practice Address - Street 2:
Practice Address - City:MONDOVI
Practice Address - State:WI
Practice Address - Zip Code:54755-1117
Practice Address - Country:US
Practice Address - Phone:715-926-4998
Practice Address - Fax:715-926-4998
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-12-30
Last Update Date:2019-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty