Provider Demographics
NPI:1083736813
Name:KAISER CHIROPRACTIC, S.C.
Entity Type:Organization
Organization Name:KAISER CHIROPRACTIC, S.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:
Authorized Official - Last Name:KAISER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:262-248-4001
Mailing Address - Street 1:790 GARDNER ST
Mailing Address - Street 2:
Mailing Address - City:LAKE GENEVA
Mailing Address - State:WI
Mailing Address - Zip Code:53147-1233
Mailing Address - Country:US
Mailing Address - Phone:262-248-4001
Mailing Address - Fax:262-248-4069
Practice Address - Street 1:790 GARDNER ST
Practice Address - Street 2:
Practice Address - City:LAKE GENEVA
Practice Address - State:WI
Practice Address - Zip Code:53147-1233
Practice Address - Country:US
Practice Address - Phone:262-248-4001
Practice Address - Fax:262-248-4069
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-04
Last Update Date:2011-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI3050-012111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WIU52560Medicare UPIN
WI000035339Medicare ID - Type Unspecified