Provider Demographics
NPI:1306387758
Name:CHIROHEALTH CARE CENTER LLC
Entity Type:Organization
Organization Name:CHIROHEALTH CARE CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:
Authorized Official - Last Name:BARANCZYK
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:920-496-1556
Mailing Address - Street 1:2668 FOREST HAVEN CT
Mailing Address - Street 2:
Mailing Address - City:SUAMICO
Mailing Address - State:WI
Mailing Address - Zip Code:54313-7968
Mailing Address - Country:US
Mailing Address - Phone:920-496-1556
Mailing Address - Fax:
Practice Address - Street 1:2201 S ONEIDA ST
Practice Address - Street 2:SUITE #2
Practice Address - City:GREEN BAY
Practice Address - State:WI
Practice Address - Zip Code:54304-4745
Practice Address - Country:US
Practice Address - Phone:920-496-1556
Practice Address - Fax:920-496-9860
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-03-18
Last Update Date:2017-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2754111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI38864600Medicaid
WIU31350Medicare UPIN
WI38864600Medicaid