Provider Demographics
NPI:1144380304
Name:ALGRIM CHIROPRACTIC OFFICE, SC
Entity Type:Organization
Organization Name:ALGRIM CHIROPRACTIC OFFICE, SC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:ROBERT
Authorized Official - Last Name:ALGRIM
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:262-886-1213
Mailing Address - Street 1:5332 SPRING ST
Mailing Address - Street 2:
Mailing Address - City:RACINE
Mailing Address - State:WI
Mailing Address - Zip Code:53406-2910
Mailing Address - Country:US
Mailing Address - Phone:262-886-1213
Mailing Address - Fax:262-886-4114
Practice Address - Street 1:5332 SPRING ST
Practice Address - Street 2:
Practice Address - City:RACINE
Practice Address - State:WI
Practice Address - Zip Code:53406-2910
Practice Address - Country:US
Practice Address - Phone:262-886-1213
Practice Address - Fax:262-886-4114
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-11
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1458111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WIT61348Medicare UPIN
WI7000075664Medicare ID - Type Unspecified