Provider Demographics
NPI:1235164211
Name:WESTWOOD CHIROPRACTIC
Entity Type:Organization
Organization Name:WESTWOOD CHIROPRACTIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:L
Authorized Official - Last Name:DRAGGOO
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:414-543-1951
Mailing Address - Street 1:PO BOX 510444
Mailing Address - Street 2:
Mailing Address - City:NEW BERLIN
Mailing Address - State:WI
Mailing Address - Zip Code:53151
Mailing Address - Country:US
Mailing Address - Phone:262-785-1811
Mailing Address - Fax:262-785-9887
Practice Address - Street 1:7639 W BELOIT ROAD
Practice Address - Street 2:
Practice Address - City:WEST ALLIS
Practice Address - State:WI
Practice Address - Zip Code:53219
Practice Address - Country:US
Practice Address - Phone:414-543-1951
Practice Address - Fax:414-543-1595
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-11
Last Update Date:2012-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI38921800Medicaid
WI38921800Medicaid