Provider Demographics
NPI:1366500654
Name:CROTTEAU CHIROPRACTIC, L.L.C
Entity Type:Organization
Organization Name:CROTTEAU CHIROPRACTIC, L.L.C
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:DONALD
Authorized Official - Last Name:CROTTEAU
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:715-234-3808
Mailing Address - Street 1:12 W MARSHALL ST
Mailing Address - Street 2:SUITE #110
Mailing Address - City:RICE LAKE
Mailing Address - State:WI
Mailing Address - Zip Code:54868-2741
Mailing Address - Country:US
Mailing Address - Phone:715-234-3808
Mailing Address - Fax:715-234-3809
Practice Address - Street 1:12 W MARSHALL ST
Practice Address - Street 2:SUITE #110
Practice Address - City:RICE LAKE
Practice Address - State:WI
Practice Address - Zip Code:54868-2741
Practice Address - Country:US
Practice Address - Phone:715-234-3808
Practice Address - Fax:715-234-3809
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-05
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI3891-012111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty