Provider Demographics
NPI:1215002399
Name:DIRKER CHIROPRACTIC LLC
Entity Type:Organization
Organization Name:DIRKER CHIROPRACTIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:JOE
Authorized Official - Middle Name:A
Authorized Official - Last Name:DIRKER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:920-451-7000
Mailing Address - Street 1:909 S TAYLOR DR
Mailing Address - Street 2:
Mailing Address - City:SHEBOYGAN
Mailing Address - State:WI
Mailing Address - Zip Code:53081-4766
Mailing Address - Country:US
Mailing Address - Phone:920-451-7000
Mailing Address - Fax:920-451-7100
Practice Address - Street 1:909 S TAYLOR DR
Practice Address - Street 2:
Practice Address - City:SHEBOYGAN
Practice Address - State:WI
Practice Address - Zip Code:53081-4766
Practice Address - Country:US
Practice Address - Phone:920-451-7000
Practice Address - Fax:920-451-7100
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-22
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI3361111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI38730000Medicaid