Provider Demographics
NPI:1164545943
Name:METRO CHIROPRACTIC CLINIC, S.C.
Entity Type:Organization
Organization Name:METRO CHIROPRACTIC CLINIC, S.C.
Other - Org Name:MEDFORD CHIROPRACTIC CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MARY
Authorized Official - Middle Name:JANE-SHNOWSKE
Authorized Official - Last Name:METROPULOS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:715-748-9342
Mailing Address - Street 1:PO BOX 424
Mailing Address - Street 2:
Mailing Address - City:MEDFORD
Mailing Address - State:WI
Mailing Address - Zip Code:54451-0424
Mailing Address - Country:US
Mailing Address - Phone:715-748-9342
Mailing Address - Fax:715-748-9342
Practice Address - Street 1:840 E BROADWAY AVE
Practice Address - Street 2:
Practice Address - City:MEDFORD
Practice Address - State:WI
Practice Address - Zip Code:54451-1586
Practice Address - Country:US
Practice Address - Phone:715-748-9342
Practice Address - Fax:715-748-9342
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-09
Last Update Date:2007-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty