Provider Demographics
NPI:1396041091
Name:CHIROMED, LLC
Entity Type:Organization
Organization Name:CHIROMED, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR OF CHIROPRACTIC
Authorized Official - Prefix:DR
Authorized Official - First Name:LEO
Authorized Official - Middle Name:
Authorized Official - Last Name:BRONSTON
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:608-781-2225
Mailing Address - Street 1:1202 COUNTY ROAD PH
Mailing Address - Street 2:SUITE 400
Mailing Address - City:ONALASKA
Mailing Address - State:WI
Mailing Address - Zip Code:54650-8439
Mailing Address - Country:US
Mailing Address - Phone:608-781-2225
Mailing Address - Fax:608-781-2495
Practice Address - Street 1:1202 COUNTY ROAD PH
Practice Address - Street 2:SUITE 400
Practice Address - City:ONALASKA
Practice Address - State:WI
Practice Address - Zip Code:54650-8439
Practice Address - Country:US
Practice Address - Phone:608-781-2225
Practice Address - Fax:608-781-2495
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-01-28
Last Update Date:2011-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI20493261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care