Provider Demographics
NPI:1407035686
Name:EAU CLAIRE CHIROPRACTIC, SC
Entity Type:Organization
Organization Name:EAU CLAIRE CHIROPRACTIC, SC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CHRIS
Authorized Official - Middle Name:HENRY
Authorized Official - Last Name:HOUGEN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:715-832-6616
Mailing Address - Street 1:4606 COMMERCE VALLEY RD
Mailing Address - Street 2:SUITE 209
Mailing Address - City:EAU CLAIRE
Mailing Address - State:WI
Mailing Address - Zip Code:54701-7074
Mailing Address - Country:US
Mailing Address - Phone:715-832-6616
Mailing Address - Fax:715-832-6454
Practice Address - Street 1:4606 COMMERCE VALLEY RD
Practice Address - Street 2:SUITE 209
Practice Address - City:EAU CLAIRE
Practice Address - State:WI
Practice Address - Zip Code:54701-7074
Practice Address - Country:US
Practice Address - Phone:715-832-6616
Practice Address - Fax:715-832-6454
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-24
Last Update Date:2012-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1754261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI38733500Medicaid
WI75541Medicare PIN