Provider Demographics
NPI:1003141615
Name:ST CROIX CHIROPRACTIC AND WELLNESS, LLC
Entity Type:Organization
Organization Name:ST CROIX CHIROPRACTIC AND WELLNESS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRACTIONER
Authorized Official - Prefix:
Authorized Official - First Name:JOY
Authorized Official - Middle Name:KATHLEEN
Authorized Official - Last Name:ZASADNY
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:715-483-9221
Mailing Address - Street 1:1651 N BEAR LAKE DR
Mailing Address - Street 2:
Mailing Address - City:DRESSER
Mailing Address - State:WI
Mailing Address - Zip Code:54009-4633
Mailing Address - Country:US
Mailing Address - Phone:715-483-9221
Mailing Address - Fax:
Practice Address - Street 1:520 S. WASHINGTON STREET
Practice Address - Street 2:
Practice Address - City:ST CROIX FALLS
Practice Address - State:WI
Practice Address - Zip Code:54024-0851
Practice Address - Country:US
Practice Address - Phone:715-483-9991
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-10-15
Last Update Date:2009-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI4404-012111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty