Provider Demographics
NPI:1083875249
Name:JUDY K RINDAL SOBOROWICZ
Entity Type:Organization
Organization Name:JUDY K RINDAL SOBOROWICZ
Other - Org Name:ACTIVE HEALTH CHIROPACTIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JUDY
Authorized Official - Middle Name:K
Authorized Official - Last Name:SOBOROWICZ
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:715-834-6333
Mailing Address - Street 1:3521 LONDON RD
Mailing Address - Street 2:
Mailing Address - City:EAU CLAIRE
Mailing Address - State:WI
Mailing Address - Zip Code:54701-7861
Mailing Address - Country:US
Mailing Address - Phone:715-834-6333
Mailing Address - Fax:
Practice Address - Street 1:3521 LONDON RD
Practice Address - Street 2:
Practice Address - City:EAU CLAIRE
Practice Address - State:WI
Practice Address - Zip Code:54701-7861
Practice Address - Country:US
Practice Address - Phone:715-834-6333
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-20
Last Update Date:2011-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI350050962OtherRAILROAD P10
WI350050961OtherMEDICARE RAILROAD P10
WICB4904OtherRAILROAD MEDICARE
WI350050961OtherMEDICARE RAILROAD P10
WIU53609Medicare UPIN
WIU51112Medicare UPIN
WI000070863Medicare PIN