Provider Demographics
NPI:1346364668
Name:DAHL FAMILY CHIROPRACTIC, SC INC
Entity Type:Organization
Organization Name:DAHL FAMILY CHIROPRACTIC, SC INC
Other - Org Name:DAHL FAMILY CHIROPRACTIC, LLC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:OWNER DOCTOR OF CHIROPRACTIC
Authorized Official - Prefix:DR
Authorized Official - First Name:ANN MARIE
Authorized Official - Middle Name:BETH
Authorized Official - Last Name:DAHL
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:608-829-0074
Mailing Address - Street 1:6626 MINERAL POINT RD
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:WI
Mailing Address - Zip Code:53705-4238
Mailing Address - Country:US
Mailing Address - Phone:608-829-0074
Mailing Address - Fax:608-829-0330
Practice Address - Street 1:6626 MINERAL POINT RD
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53705-4238
Practice Address - Country:US
Practice Address - Phone:608-829-0074
Practice Address - Fax:608-829-0330
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-19
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI4304111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME1134180730Medicare UPIN