Provider Demographics
NPI:1083660625
Name:CHIROPRACTIC COMPANY - GREENFIELD WEST LLC
Entity Type:Organization
Organization Name:CHIROPRACTIC COMPANY - GREENFIELD WEST LLC
Other - Org Name:CHIROPRACTIC COMPANY - GREENFIELD WEST
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:P
Authorized Official - Last Name:CORSI
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:414-354-5377
Mailing Address - Street 1:3823 S 108TH ST
Mailing Address - Street 2:
Mailing Address - City:GREENFIELD
Mailing Address - State:WI
Mailing Address - Zip Code:53228-1336
Mailing Address - Country:US
Mailing Address - Phone:414-327-6400
Mailing Address - Fax:
Practice Address - Street 1:3823 S 108TH ST
Practice Address - Street 2:
Practice Address - City:GREENFIELD
Practice Address - State:WI
Practice Address - Zip Code:53228-1336
Practice Address - Country:US
Practice Address - Phone:414-327-6400
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-25
Last Update Date:2024-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI3725111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WIU83336Medicare UPIN