Provider Demographics
NPI:1326108077
Name:JOLIN CHIROPRACTIC CENTER SC
Entity Type:Organization
Organization Name:JOLIN CHIROPRACTIC CENTER SC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:ALAN
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:JOLIN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:715-339-6151
Mailing Address - Street 1:596 SOUTH LAKE AVENUE
Mailing Address - Street 2:
Mailing Address - City:PHILLIPS
Mailing Address - State:WI
Mailing Address - Zip Code:54555-1411
Mailing Address - Country:US
Mailing Address - Phone:715-339-6151
Mailing Address - Fax:715-339-6158
Practice Address - Street 1:596 SOUTH LAKE AVENUE
Practice Address - Street 2:
Practice Address - City:PHILLIPS
Practice Address - State:WI
Practice Address - Zip Code:54555-1411
Practice Address - Country:US
Practice Address - Phone:715-339-6151
Practice Address - Fax:715-339-6158
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-11
Last Update Date:2008-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2285012111N00000X, 111NR0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
No111NR0200XChiropractic ProvidersChiropractorRadiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WIP00003901OtherRAILROAD MEDICARE
WI38941200Medicaid
WI=========010OtherBC BS
64748Medicare UPIN