Provider Demographics
NPI:1003975038
Name:COULEE CHIROPRACTIC CLINIC, S.C.
Entity Type:Organization
Organization Name:COULEE CHIROPRACTIC CLINIC, S.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:H
Authorized Official - Last Name:WOODRUFF
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:608-782-6604
Mailing Address - Street 1:600 3RD ST N
Mailing Address - Street 2:SUITE 201
Mailing Address - City:LA CROSSE
Mailing Address - State:WI
Mailing Address - Zip Code:54601-6299
Mailing Address - Country:US
Mailing Address - Phone:608-782-6604
Mailing Address - Fax:608-782-6335
Practice Address - Street 1:600 3RD ST N
Practice Address - Street 2:SUITE 201
Practice Address - City:LA CROSSE
Practice Address - State:WI
Practice Address - Zip Code:54601-6299
Practice Address - Country:US
Practice Address - Phone:608-782-6604
Practice Address - Fax:608-782-6335
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-06
Last Update Date:2014-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI000090256Medicare ID - Type Unspecified