Provider Demographics
NPI:1043884836
Name:FOUNDATIONS PEDIATRIC AND FAMILY CHIROPRACTIC
Entity Type:Organization
Organization Name:FOUNDATIONS PEDIATRIC AND FAMILY CHIROPRACTIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DC
Authorized Official - Prefix:DR
Authorized Official - First Name:TREVOR
Authorized Official - Middle Name:
Authorized Official - Last Name:SECRAW
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:715-924-2998
Mailing Address - Street 1:PO BOX 621
Mailing Address - Street 2:
Mailing Address - City:CHETEK
Mailing Address - State:WI
Mailing Address - Zip Code:54728-0621
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:600 1ST ST
Practice Address - Street 2:
Practice Address - City:CHETEK
Practice Address - State:WI
Practice Address - Zip Code:54728-4128
Practice Address - Country:US
Practice Address - Phone:715-924-2998
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-05-17
Last Update Date:2021-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty