| Russell Chiropractic Llc | |
|
425 Bridge St, Cornell, WI 54732-8391 | |
| (715) 239-0909 | |
| (715) 239-0908 |
| Full Name | Russell Chiropractic Llc |
|---|---|
| Type | Facility |
| Speciality | Chiropractor |
| Location | 425 Bridge St, Cornell, Wisconsin |
| Accepts Medicare Assignments | Medicare enrolled and accepts medicare insurance. Providers at this facility may prescribe medicare part D drugs. |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1548567662 | NPI | - | NPPES |
| 38183500 | Medicaid | WI |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 111N00000X | Chiropractor | 4384012 (Wisconsin) | Primary |
| Provider Name | Jacquelyn M Russell |
|---|---|
| Provider Type | Practitioner - Chiropractic |
| Provider Identifiers | NPI Number: 1669560413 PECOS PAC ID: 2365512787 Enrollment ID: I20080528000286 |
| Provider Name | Keith A Levick |
|---|---|
| Provider Type | Practitioner - Chiropractic |
| Provider Identifiers | NPI Number: 1891986501 PECOS PAC ID: 3375616238 Enrollment ID: I20080725000082 |
| Mailing Address | Practice Location Address |
|---|---|
| Russell Chiropractic Llc 425 Bridge St, Cornell, WI 54732-8391 Ph: (715) 239-0909 | Russell Chiropractic Llc 425 Bridge St, Cornell, WI 54732-8391 Ph: (715) 239-0909 |
Cornell Chiropractic, Llc Chiropractor Medicare: Not Enrolled in Medicare Practice Location: 425 Bridge St, Cornell, WI 54732 Phone: 715-239-0909 | |
Dr. Jacquelyn Michele Russell, D.C. Chiropractor Medicare: Accepting Medicare Assignments Practice Location: 425 Bridge St, Cornell, WI 54732 Phone: 715-239-0909 Fax: 715-239-0908 |