52D0396357 CLIA NUMBER - BLACK RIVER CHIROPRACTIC CLINIC

Laboratory Demographics

  • CLIA Code: 52D0396357
  • Facility Name: BLACK RIVER CHIROPRACTIC CLINIC
  • Facility Address: 126 S 2ND ST
    BLACK RIVER FALLS, WI
    ZIP 54615
  • Facility Phone: 715 284-2915
  • Facility Type: Practitioner Other
  • Facility Type: Waiver
  • Lab Director: DR. CHANELLE R. HOLLIDAY
  • NPI Number: 1396746186
  • Taxonomy: 111N00000X - Chiropractor

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CLIA Record

Field Name Field Value
CLIA Number 52D0396357
LAB Type Practitioner Other
Facility Name BLACK RIVER CHIROPRACTIC CLINIC
Street 126 S 2ND ST
City BLACK RIVER FALLS
State WI
ZIP 54615
Phone 715 284-2915
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 9/1/2024
Certificate Expiration Date 8/31/2026
Facility Type Practitioner Other
Lab Director DR. CHANELLE R. HOLLIDAY

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This page was last updated on: 9/29/2025