Provider Demographics
NPI:1053461772
Name:NEW HEALTH CHIROPRACTIC & INTERGRATED HEALTHCARE, LLC
Entity Type:Organization
Organization Name:NEW HEALTH CHIROPRACTIC & INTERGRATED HEALTHCARE, LLC
Other - Org Name:DYNAMIC CHIROPRACTIC CLINIC OF FITCHBURG, LLC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:OWNER/DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:KURT
Authorized Official - Middle Name:ROBERT
Authorized Official - Last Name:STEIN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:608-273-2222
Mailing Address - Street 1:5976 EXECUTIVE DRIVE
Mailing Address - Street 2:SUITE C
Mailing Address - City:FITCHBURG
Mailing Address - State:WI
Mailing Address - Zip Code:53719
Mailing Address - Country:US
Mailing Address - Phone:608-273-2222
Mailing Address - Fax:608-273-2227
Practice Address - Street 1:5976 EXECUTIVE DRIVE
Practice Address - Street 2:SUITE C
Practice Address - City:FITCHBURG
Practice Address - State:WI
Practice Address - Zip Code:53719
Practice Address - Country:US
Practice Address - Phone:608-273-2222
Practice Address - Fax:608-273-2227
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-12
Last Update Date:2013-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI3835261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI38940000Medicaid
WI000035592Medicare ID - Type Unspecified
WI38940000Medicaid