Provider Demographics
NPI:1285818625
Name:THIRD WARD CHIROPRACTIC SC
Entity Type:Organization
Organization Name:THIRD WARD CHIROPRACTIC SC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:C
Authorized Official - Last Name:NEUBER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:262-363-7545
Mailing Address - Street 1:150 N JEFFERSON ST
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53202-6110
Mailing Address - Country:US
Mailing Address - Phone:414-271-1717
Mailing Address - Fax:
Practice Address - Street 1:150 N. JEFFERSON ST.
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53202-6110
Practice Address - Country:US
Practice Address - Phone:414-271-1717
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-20
Last Update Date:2009-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2797111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI70776OtherMEDICARE
WI70776OtherMEDICARE