Provider Demographics
NPI:1275558009
Name:MENOMONIE CHIROPRACTIC CENTER SC
Entity Type:Organization
Organization Name:MENOMONIE CHIROPRACTIC CENTER SC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CHRISTIAN
Authorized Official - Middle Name:N
Authorized Official - Last Name:MEYER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:715-232-8858
Mailing Address - Street 1:3120 SCHNEIDER AVE SE
Mailing Address - Street 2:STE # 5
Mailing Address - City:MENOMONIE
Mailing Address - State:WI
Mailing Address - Zip Code:54751-2591
Mailing Address - Country:US
Mailing Address - Phone:715-232-8858
Mailing Address - Fax:715-232-8868
Practice Address - Street 1:3120 SCHNEIDER AVE SE
Practice Address - Street 2:STE # 5
Practice Address - City:MENOMONIE
Practice Address - State:WI
Practice Address - Zip Code:54751-2591
Practice Address - Country:US
Practice Address - Phone:715-232-8858
Practice Address - Fax:715-232-8868
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-13
Last Update Date:2011-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2793111N00000X
WI2849111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI75805Medicare ID - Type Unspecified
U31229Medicare UPIN
U30042Medicare UPIN