Provider Demographics
NPI:1003973868
Name:RIVERSIDE CHIROPRACTIC, LLC
Entity Type:Organization
Organization Name:RIVERSIDE CHIROPRACTIC, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER-MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:JENNY
Authorized Official - Middle Name:R
Authorized Official - Last Name:GEIGER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:2625-143-6000
Mailing Address - Street 1:104 E MAIN ST
Mailing Address - Street 2:LOWER
Mailing Address - City:WATERFORD
Mailing Address - State:WI
Mailing Address - Zip Code:53185-4302
Mailing Address - Country:US
Mailing Address - Phone:262-514-3600
Mailing Address - Fax:262-514-3836
Practice Address - Street 1:104 E MAIN ST
Practice Address - Street 2:LOWER
Practice Address - City:WATERFORD
Practice Address - State:WI
Practice Address - Zip Code:53185-4302
Practice Address - Country:US
Practice Address - Phone:262-514-3600
Practice Address - Fax:262-514-3836
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-02
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI3469-012111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty