Provider Demographics
NPI:1346506722
Name:FAMILY CHIROPRACTIC CLINIC OF MONROE,S.C.
Entity Type:Organization
Organization Name:FAMILY CHIROPRACTIC CLINIC OF MONROE,S.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:J
Authorized Official - Last Name:THOMPSON
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:608-325-1999
Mailing Address - Street 1:PO BOX 60
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:WI
Mailing Address - Zip Code:53566-0060
Mailing Address - Country:US
Mailing Address - Phone:608-325-1999
Mailing Address - Fax:608-325-1997
Practice Address - Street 1:1730 10TH ST
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:WI
Practice Address - Zip Code:53566-1827
Practice Address - Country:US
Practice Address - Phone:608-325-1999
Practice Address - Fax:608-325-1997
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-04-10
Last Update Date:2012-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI3280111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty