Provider Demographics
NPI:1144419714
Name:BADGER HEALTH CENTER SC
Entity Type:Organization
Organization Name:BADGER HEALTH CENTER SC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOCELYN
Authorized Official - Middle Name:K
Authorized Official - Last Name:HALLEN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:262-547-2250
Mailing Address - Street 1:1353 S WEST AVE
Mailing Address - Street 2:
Mailing Address - City:WAUKESHA
Mailing Address - State:WI
Mailing Address - Zip Code:53186-5943
Mailing Address - Country:US
Mailing Address - Phone:262-547-2250
Mailing Address - Fax:
Practice Address - Street 1:1353 S WEST AVE
Practice Address - Street 2:
Practice Address - City:WAUKESHA
Practice Address - State:WI
Practice Address - Zip Code:53186-5943
Practice Address - Country:US
Practice Address - Phone:262-547-2250
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-19
Last Update Date:2009-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI3684012111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty