Provider Demographics
NPI:1093071904
Name:CLIFFORD CHIROPRACTIC, INC.
Entity Type:Organization
Organization Name:CLIFFORD CHIROPRACTIC, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:BECKY
Authorized Official - Middle Name:LOUISE
Authorized Official - Last Name:FLISS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:715-355-9009
Mailing Address - Street 1:1957 CTY RD. XX
Mailing Address - Street 2:
Mailing Address - City:MOSINEE
Mailing Address - State:WI
Mailing Address - Zip Code:54455-9026
Mailing Address - Country:US
Mailing Address - Phone:715-355-9009
Mailing Address - Fax:715-355-9109
Practice Address - Street 1:1957 CTY RD. XX
Practice Address - Street 2:
Practice Address - City:MOSINEE
Practice Address - State:WI
Practice Address - Zip Code:54455-9026
Practice Address - Country:US
Practice Address - Phone:715-355-9009
Practice Address - Fax:715-355-9109
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-04-04
Last Update Date:2012-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI38942900Medicaid
WI38942900Medicaid