Provider Demographics
NPI:1164756110
Name:DOUSMAN CHIROPRACTIC CLINIC SC
Entity Type:Organization
Organization Name:DOUSMAN CHIROPRACTIC CLINIC SC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/SECT.
Authorized Official - Prefix:
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:A
Authorized Official - Last Name:DONLEY
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:920-699-4060
Mailing Address - Street 1:W4489 AMBROSE RD
Mailing Address - Street 2:
Mailing Address - City:JOHNSON CREEK
Mailing Address - State:WI
Mailing Address - Zip Code:53038
Mailing Address - Country:US
Mailing Address - Phone:920-699-4060
Mailing Address - Fax:920-699-4060
Practice Address - Street 1:W4489 AMBROSE RD
Practice Address - Street 2:
Practice Address - City:JOHNSON CREEK
Practice Address - State:WI
Practice Address - Zip Code:53038
Practice Address - Country:US
Practice Address - Phone:920-699-4060
Practice Address - Fax:920-699-4060
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-09-23
Last Update Date:2009-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2878-012111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty