Provider Demographics
NPI:1356485437
Name:PEAK CARE CLINIC
Entity Type:Organization
Organization Name:PEAK CARE CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:
Authorized Official - Last Name:JONES
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:262-957-6715
Mailing Address - Street 1:N63W23524 SILVER SPRING DR STOP 4
Mailing Address - Street 2:
Mailing Address - City:SUSSEX
Mailing Address - State:WI
Mailing Address - Zip Code:53089-3897
Mailing Address - Country:US
Mailing Address - Phone:262-409-6754
Mailing Address - Fax:262-246-8894
Practice Address - Street 1:N63W23524 SILVER SPRING DR STOP 4
Practice Address - Street 2:
Practice Address - City:SUSSEX
Practice Address - State:WI
Practice Address - Zip Code:53089-3897
Practice Address - Country:US
Practice Address - Phone:262-409-6754
Practice Address - Fax:262-246-8894
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-20
Last Update Date:2022-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI3576-012111N00000X
111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WIU95619Medicare UPIN