Provider Demographics
NPI:1093236408
Name:PLOVER CHIROPRACTIC CENTER SC
Entity Type:Organization
Organization Name:PLOVER CHIROPRACTIC CENTER SC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ERIC
Authorized Official - Middle Name:
Authorized Official - Last Name:LIAZUK
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:715-342-4027
Mailing Address - Street 1:1840 POST RD STE 6
Mailing Address - Street 2:
Mailing Address - City:PLOVER
Mailing Address - State:WI
Mailing Address - Zip Code:54467-2832
Mailing Address - Country:US
Mailing Address - Phone:715-342-4027
Mailing Address - Fax:
Practice Address - Street 1:1840 POST RD STE 6
Practice Address - Street 2:
Practice Address - City:PLOVER
Practice Address - State:WI
Practice Address - Zip Code:54467-2832
Practice Address - Country:US
Practice Address - Phone:715-342-4027
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-07-06
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI4181-12111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI38965500Medicaid