Provider Demographics
NPI:1033270368
Name:RHINELANDER CHIROPRACTIC, S.C.
Entity Type:Organization
Organization Name:RHINELANDER CHIROPRACTIC, S.C.
Other - Org Name:MCKITRICK CHIROPRACTIC OFFIC SC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:GREGORY
Authorized Official - Middle Name:STANFORD
Authorized Official - Last Name:MICHALS
Authorized Official - Suffix:JR
Authorized Official - Credentials:DC
Authorized Official - Phone:715-362-5522
Mailing Address - Street 1:201 E. ANDERSON ST.
Mailing Address - Street 2:SUITE A
Mailing Address - City:RHINELANDER
Mailing Address - State:WI
Mailing Address - Zip Code:54501
Mailing Address - Country:US
Mailing Address - Phone:715-362-5522
Mailing Address - Fax:715-362-5591
Practice Address - Street 1:201 E. ANDERSON ST.
Practice Address - Street 2:SUITE A
Practice Address - City:RHINELANDER
Practice Address - State:WI
Practice Address - Zip Code:54501
Practice Address - Country:US
Practice Address - Phone:715-362-5522
Practice Address - Fax:715-362-5591
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-12
Last Update Date:2017-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1279-012111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI38816500Medicaid
WI1279-012OtherSTATE LICENSE #
WI38981300Medicaid
WI38816500Medicaid
WI38981300Medicaid