Provider Demographics
NPI:1295838670
Name:THREE RIVERS CHIROPRACTIC LLC
Entity Type:Organization
Organization Name:THREE RIVERS CHIROPRACTIC LLC
Other - Org Name:M.Y. LIFE HEALTH CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICER CO OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CHAD
Authorized Official - Middle Name:W
Authorized Official - Last Name:SCHULTZ
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:608-783-3040
Mailing Address - Street 1:2946 DARLING COURT
Mailing Address - Street 2:
Mailing Address - City:LACROSSE
Mailing Address - State:WI
Mailing Address - Zip Code:54601
Mailing Address - Country:US
Mailing Address - Phone:608-783-3040
Mailing Address - Fax:844-248-2389
Practice Address - Street 1:2946 DARLING COURT
Practice Address - Street 2:
Practice Address - City:LACROSSE
Practice Address - State:WI
Practice Address - Zip Code:54601
Practice Address - Country:US
Practice Address - Phone:608-783-3040
Practice Address - Fax:844-248-2389
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-07
Last Update Date:2023-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WIDN3556OtherMEDICARE RAILROAD GROUP PIN
WIDN3556OtherMEDICARE RAILROAD GROUP PIN