Provider Demographics
NPI:1104025261
Name:FALL CREEK CHIROPRACTIC INC.
Entity Type:Organization
Organization Name:FALL CREEK CHIROPRACTIC INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ERIN
Authorized Official - Middle Name:
Authorized Official - Last Name:SCOTT
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:715-877-2880
Mailing Address - Street 1:301 W LINCOLN AVE
Mailing Address - Street 2:POB 338
Mailing Address - City:FALL CREEK
Mailing Address - State:WI
Mailing Address - Zip Code:54742-9363
Mailing Address - Country:US
Mailing Address - Phone:715-877-2880
Mailing Address - Fax:715-877-3451
Practice Address - Street 1:301 W LINCOLN AVE
Practice Address - Street 2:
Practice Address - City:FALL CREEK
Practice Address - State:WI
Practice Address - Zip Code:54742-9362
Practice Address - Country:US
Practice Address - Phone:715-877-2880
Practice Address - Fax:715-877-3451
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-17
Last Update Date:2022-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1583-012111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI38827700Medicaid
WI000035728Medicare Oscar/Certification
WI1386704484Medicare UPIN
WI38827700Medicaid