Provider Demographics
NPI:1114367828
Name:RESTORATION CHIROPRACTIC, LLC
Entity Type:Organization
Organization Name:RESTORATION CHIROPRACTIC, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JUDITH
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:DOCHNAHL
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:563-687-8087
Mailing Address - Street 1:4024 ESCH RD
Mailing Address - Street 2:
Mailing Address - City:DODGEVILLE
Mailing Address - State:WI
Mailing Address - Zip Code:53533-8740
Mailing Address - Country:US
Mailing Address - Phone:563-587-8087
Mailing Address - Fax:563-587-8088
Practice Address - Street 1:4024 ESCH RD
Practice Address - Street 2:
Practice Address - City:DODGEVILLE
Practice Address - State:WI
Practice Address - Zip Code:53533-8740
Practice Address - Country:US
Practice Address - Phone:563-587-8087
Practice Address - Fax:563-587-8088
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-06-26
Last Update Date:2014-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI3435-012261Q00000X
IA007484261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI000035216Medicare PIN
IAIB2836Medicare PIN