Provider Demographics
NPI:1073548517
Name:ORTH, ALLEN CRAIG (DC, CCEP, CSCS)
Entity Type:Individual
Prefix:DR
First Name:ALLEN
Middle Name:CRAIG
Last Name:ORTH
Suffix:
Gender:M
Credentials:DC, CCEP, CSCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4747 CRYSTAL LAKE RD
Mailing Address - Street 2:
Mailing Address - City:RHINELANDER
Mailing Address - State:WI
Mailing Address - Zip Code:54501-9722
Mailing Address - Country:US
Mailing Address - Phone:715-369-5202
Mailing Address - Fax:
Practice Address - Street 1:1818 N STEVENS ST
Practice Address - Street 2:
Practice Address - City:RHINELANDER
Practice Address - State:WI
Practice Address - Zip Code:54501-2129
Practice Address - Country:US
Practice Address - Phone:715-369-4000
Practice Address - Fax:715-369-5798
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-12
Last Update Date:2013-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI3824-012111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI38937300Medicaid
WI38937300Medicaid