Provider Demographics
NPI:1386843977
Name:ENLOE CHIROPRACTIC LLC
Entity Type:Organization
Organization Name:ENLOE CHIROPRACTIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:WAYNE
Authorized Official - Middle Name:T
Authorized Official - Last Name:ENLOE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:608-831-0453
Mailing Address - Street 1:1424 N HIGH POINT RD
Mailing Address - Street 2:SUITE 201
Mailing Address - City:MIDDLETON
Mailing Address - State:WI
Mailing Address - Zip Code:53562-3682
Mailing Address - Country:US
Mailing Address - Phone:608-831-0453
Mailing Address - Fax:608-836-4884
Practice Address - Street 1:1424 N HIGH POINT RD
Practice Address - Street 2:SUITE 201
Practice Address - City:MIDDLETON
Practice Address - State:WI
Practice Address - Zip Code:53562-3682
Practice Address - Country:US
Practice Address - Phone:608-831-0453
Practice Address - Fax:608-836-4884
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-13
Last Update Date:2012-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI3418-012111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI38901500Medicaid
WI38901500Medicaid
WI000135210Medicare PIN