Provider Demographics
NPI:1225425226
Name:WAUKESHA FAMILY CHIROPRACTIC, LLC
Entity Type:Organization
Organization Name:WAUKESHA FAMILY CHIROPRACTIC, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KATIE
Authorized Official - Middle Name:
Authorized Official - Last Name:SAM
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:262-501-2995
Mailing Address - Street 1:411 N GRAND AVE
Mailing Address - Street 2:
Mailing Address - City:WAUKESHA
Mailing Address - State:WI
Mailing Address - Zip Code:53186-4961
Mailing Address - Country:US
Mailing Address - Phone:262-501-2995
Mailing Address - Fax:262-521-1005
Practice Address - Street 1:411 N GRAND AVE
Practice Address - Street 2:
Practice Address - City:WAUKESHA
Practice Address - State:WI
Practice Address - Zip Code:53186-4961
Practice Address - Country:US
Practice Address - Phone:262-501-2995
Practice Address - Fax:262-521-1005
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-04-17
Last Update Date:2015-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI4581-012111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty