Provider Demographics
NPI:1093978611
Name:WALL FAMILY CHIROPRACTIC LLC
Entity Type:Organization
Organization Name:WALL FAMILY CHIROPRACTIC LLC
Other - Org Name:HEALTHRITE FAMILY CHIROPRACTIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:TRACI
Authorized Official - Middle Name:
Authorized Official - Last Name:WALL
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:414-774-2300
Mailing Address - Street 1:8812 W NORTH AVE
Mailing Address - Street 2:
Mailing Address - City:WAUWATOSA
Mailing Address - State:WI
Mailing Address - Zip Code:53226-2726
Mailing Address - Country:US
Mailing Address - Phone:414-774-2300
Mailing Address - Fax:414-774-0341
Practice Address - Street 1:8812 W NORTH AVE
Practice Address - Street 2:
Practice Address - City:WAUWATOSA
Practice Address - State:WI
Practice Address - Zip Code:53226-2726
Practice Address - Country:US
Practice Address - Phone:414-774-2300
Practice Address - Fax:414-774-0341
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-03
Last Update Date:2008-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI4199-012111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty