Provider Demographics
NPI:1376017517
Name:CHIROPRACTIC COMPANY - WEST ALLIS EAST LTD
Entity Type:Organization
Organization Name:CHIROPRACTIC COMPANY - WEST ALLIS EAST LTD
Other - Org Name:CHIROPRACTIC COMPANY
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 1:11129 N WAUWATOSA RD
Mailing Address - Street 2:
Mailing Address - City:MEQUON
Mailing Address - State:WI
Mailing Address - Zip Code:53097-3431
Mailing Address - Country:US
Mailing Address - Phone:414-354-5377
Mailing Address - Fax:414-354-0523
Practice Address - Street 1:10025 W GREENFIELD AVE STE 100
Practice Address - Street 2:
Practice Address - City:WEST ALLIS
Practice Address - State:WI
Practice Address - Zip Code:53214-3957
Practice Address - Country:US
Practice Address - Phone:414-258-9777
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CHIROPRACTIC COMPANY S.C.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2019-01-21
Last Update Date:2024-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty