Provider Demographics
NPI:1033388400
Name:CHIROPRACTIC COMPLETE SC
Entity Type:Organization
Organization Name:CHIROPRACTIC COMPLETE SC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINIC DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:DANIEL
Authorized Official - Last Name:CULLIGAN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:414-422-1010
Mailing Address - Street 1:S74W16845 JANESVILLE RD
Mailing Address - Street 2:
Mailing Address - City:MUSKEGO
Mailing Address - State:WI
Mailing Address - Zip Code:53150-8618
Mailing Address - Country:US
Mailing Address - Phone:414-422-1010
Mailing Address - Fax:414-422-1040
Practice Address - Street 1:S74W16845 JANESVILLE RD
Practice Address - Street 2:
Practice Address - City:MUSKEGO
Practice Address - State:WI
Practice Address - Zip Code:53150-8618
Practice Address - Country:US
Practice Address - Phone:414-422-1010
Practice Address - Fax:414-422-1040
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-29
Last Update Date:2013-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI4052012111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI000035858Medicare PIN