Provider Demographics
NPI:1275566606
Name:APPLE CLINIC SC
Entity Type:Organization
Organization Name:APPLE CLINIC SC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/CHIROPRACTOR
Authorized Official - Prefix:
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:LINN
Authorized Official - Last Name:RADA
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:920-686-0328
Mailing Address - Street 1:814 JAY ST
Mailing Address - Street 2:
Mailing Address - City:MANITOWOC
Mailing Address - State:WI
Mailing Address - Zip Code:54220-4520
Mailing Address - Country:US
Mailing Address - Phone:920-686-0328
Mailing Address - Fax:920-686-1035
Practice Address - Street 1:814 JAY ST
Practice Address - Street 2:
Practice Address - City:MANITOWOC
Practice Address - State:WI
Practice Address - Zip Code:54220-4520
Practice Address - Country:US
Practice Address - Phone:920-686-0328
Practice Address - Fax:920-686-1035
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-09
Last Update Date:2012-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI3703012111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI38927900Medicaid
WI000038135Medicare ID - Type Unspecified
WI38927900Medicaid