Provider Demographics
NPI:1295012219
Name:RIVER CITY CHIROPRACTIC INC
Entity Type:Organization
Organization Name:RIVER CITY CHIROPRACTIC INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:COREY
Authorized Official - Middle Name:STEPHEN
Authorized Official - Last Name:HARRIS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:608-408-2488
Mailing Address - Street 1:205 GREEN ST
Mailing Address - Street 2:STE 102
Mailing Address - City:ONALASKA
Mailing Address - State:WI
Mailing Address - Zip Code:54650-3329
Mailing Address - Country:US
Mailing Address - Phone:608-408-2488
Mailing Address - Fax:855-545-8127
Practice Address - Street 1:205 GREEN ST
Practice Address - Street 2:STE 102
Practice Address - City:ONALASKA
Practice Address - State:WI
Practice Address - Zip Code:54650-3329
Practice Address - Country:US
Practice Address - Phone:612-799-6442
Practice Address - Fax:855-545-8127
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-11-04
Last Update Date:2012-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI5034111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty