Provider Demographics
NPI:1215356753
Name:CREAM CITY CHIROPRACTIC
Entity Type:Organization
Organization Name:CREAM CITY CHIROPRACTIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JON
Authorized Official - Middle Name:
Authorized Official - Last Name:DURIS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:414-489-7911
Mailing Address - Street 1:435 E LINCOLN AVE
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53207-1756
Mailing Address - Country:US
Mailing Address - Phone:414-489-7911
Mailing Address - Fax:
Practice Address - Street 1:435 E LINCOLN AVE
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53207-1756
Practice Address - Country:US
Practice Address - Phone:414-489-7911
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-04-14
Last Update Date:2014-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI4583-012261QH0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service