Provider Demographics
NPI:1073702007
Name:NEENAH CHIROPRACTIC & REHAB INC
Entity Type:Organization
Organization Name:NEENAH CHIROPRACTIC & REHAB INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ERIC
Authorized Official - Middle Name:
Authorized Official - Last Name:BOGAART
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:920-722-9200
Mailing Address - Street 1:907 TULLAR RD
Mailing Address - Street 2:
Mailing Address - City:NEENAH
Mailing Address - State:WI
Mailing Address - Zip Code:54956-3617
Mailing Address - Country:US
Mailing Address - Phone:920-722-9200
Mailing Address - Fax:920-722-9202
Practice Address - Street 1:907 TULLAR RD
Practice Address - Street 2:
Practice Address - City:NEENAH
Practice Address - State:WI
Practice Address - Zip Code:54956-3617
Practice Address - Country:US
Practice Address - Phone:920-722-9200
Practice Address - Fax:920-722-9202
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-16
Last Update Date:2018-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI4143012111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI38964100Medicaid
WI38964100Medicaid