Provider Demographics
NPI:1366502734
Name:CHIROPRACTIC COMPANY - GREENFIELD II LTD
Entity Type:Organization
Organization Name:CHIROPRACTIC COMPANY - GREENFIELD II LTD
Other - Org Name:CHIROPRACTIC COMPANY - GREENFIELD II LTD
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:P
Authorized Official - Last Name:CORSI
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:414-354-5377
Mailing Address - Street 1:4600 W LOOMIS RD
Mailing Address - Street 2:SUITE 110
Mailing Address - City:GREENFIELD
Mailing Address - State:WI
Mailing Address - Zip Code:53220-4858
Mailing Address - Country:US
Mailing Address - Phone:414-481-1021
Mailing Address - Fax:414-481-3044
Practice Address - Street 1:4600 W LOOMIS RD
Practice Address - Street 2:SUITE 110
Practice Address - City:GREENFIELD
Practice Address - State:WI
Practice Address - Zip Code:53220-4858
Practice Address - Country:US
Practice Address - Phone:414-481-1021
Practice Address - Fax:414-271-1727
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CHIROPRACTIC COMPANY S.C.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-12-08
Last Update Date:2023-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI35686Medicare ID - Type Unspecified
WI70560Medicare ID - Type Unspecified