Provider Demographics
NPI:1982241899
Name:ESSENCE FAMILY CHIROPRACTIC LLC
Entity Type:Organization
Organization Name:ESSENCE FAMILY CHIROPRACTIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KATELYN
Authorized Official - Middle Name:ELAINE
Authorized Official - Last Name:NIELSEN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:262-354-8252
Mailing Address - Street 1:N56W39325 WISCONSIN AVE UNIT B
Mailing Address - Street 2:
Mailing Address - City:OCONOMOWOC
Mailing Address - State:WI
Mailing Address - Zip Code:53066-2192
Mailing Address - Country:US
Mailing Address - Phone:262-354-8252
Mailing Address - Fax:
Practice Address - Street 1:N56W39325 WISCONSIN AVE UNIT B
Practice Address - Street 2:
Practice Address - City:OCONOMOWOC
Practice Address - State:WI
Practice Address - Zip Code:53066-2192
Practice Address - Country:US
Practice Address - Phone:262-354-8252
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-12-10
Last Update Date:2020-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty