Provider Demographics
NPI:1023182433
Name:FRAIN FAMILY CHIROPRACTIC WELLNESS CENTER, LTD.
Entity Type:Organization
Organization Name:FRAIN FAMILY CHIROPRACTIC WELLNESS CENTER, LTD.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:H
Authorized Official - Last Name:FRAIN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:920-499-1333
Mailing Address - Street 1:860 HANSEN RD
Mailing Address - Street 2:
Mailing Address - City:GREEN BAY
Mailing Address - State:WI
Mailing Address - Zip Code:54304-5324
Mailing Address - Country:US
Mailing Address - Phone:920-499-1333
Mailing Address - Fax:920-499-2444
Practice Address - Street 1:860 HANSEN RD
Practice Address - Street 2:
Practice Address - City:GREEN BAY
Practice Address - State:WI
Practice Address - Zip Code:54304-5324
Practice Address - Country:US
Practice Address - Phone:920-499-1333
Practice Address - Fax:920-499-2444
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-17
Last Update Date:2019-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI=========012OtherBCBSWI