Provider Demographics
NPI:1053497883
Name:BLACK, CURTIS F (DC)
Entity Type:Individual
Prefix:DR
First Name:CURTIS
Middle Name:F
Last Name:BLACK
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3004 GOLF RD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:EAU CLAIRE
Mailing Address - State:WI
Mailing Address - Zip Code:54701
Mailing Address - Country:US
Mailing Address - Phone:715-834-4516
Mailing Address - Fax:715-834-0552
Practice Address - Street 1:3004 GOLF RD
Practice Address - Street 2:SUITE 100
Practice Address - City:EAU CLAIRE
Practice Address - State:WI
Practice Address - Zip Code:54701
Practice Address - Country:US
Practice Address - Phone:715-834-4516
Practice Address - Fax:715-834-0552
Is Sole Proprietor?:No
Enumeration Date:2006-10-27
Last Update Date:2011-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2481111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI38844100Medicaid
WI38844100Medicaid
WI000270525Medicare PIN