Provider Demographics
NPI:1376687913
Name:STRATFORD CHIROPRACTIC CLINIC
Entity Type:Organization
Organization Name:STRATFORD CHIROPRACTIC CLINIC
Other - Org Name:QUEDNOW CHIROPRACTIC CLINIC, LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DC OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CARMEN
Authorized Official - Middle Name:LOUISE
Authorized Official - Last Name:QUEDNOW
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:715-687-3400
Mailing Address - Street 1:223 NORTH 3 AVENUE
Mailing Address - Street 2:SUITE D
Mailing Address - City:STRATFORD
Mailing Address - State:WI
Mailing Address - Zip Code:54484
Mailing Address - Country:US
Mailing Address - Phone:715-687-3400
Mailing Address - Fax:
Practice Address - Street 1:223 NORTH 3RD AVENUE
Practice Address - Street 2:SUITE D
Practice Address - City:STRATFORD
Practice Address - State:WI
Practice Address - Zip Code:54484
Practice Address - Country:US
Practice Address - Phone:715-687-3400
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:QUEDNOW CHIROPRACTIC CLINIC, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-02-16
Last Update Date:2008-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI3065111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI38875800Medicaid
WI000070603Medicare ID - Type Unspecified
WI38875800Medicaid