Provider Demographics
NPI:1326345166
Name:CROSSROADS CHIROPRACTIC JOHNSON CREEK LLC
Entity Type:Organization
Organization Name:CROSSROADS CHIROPRACTIC JOHNSON CREEK LLC
Other - Org Name:CROSSROADS CHIROPRACTIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:KIMBERLY
Authorized Official - Middle Name:D
Authorized Official - Last Name:TURNER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:920-728-4070
Mailing Address - Street 1:PO BOX 117
Mailing Address - Street 2:
Mailing Address - City:JOHNSON CREEK
Mailing Address - State:WI
Mailing Address - Zip Code:53038-0117
Mailing Address - Country:US
Mailing Address - Phone:920-728-4070
Mailing Address - Fax:
Practice Address - Street 1:545 VILLAGE WALK LN
Practice Address - Street 2:SUITE C
Practice Address - City:JOHNSON CREEK
Practice Address - State:WI
Practice Address - Zip Code:53038
Practice Address - Country:US
Practice Address - Phone:920-728-4070
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-02-14
Last Update Date:2011-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI4573-012111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty