Provider Demographics
NPI:1417136482
Name:WEST ALLIS CHIROPRACTIC & REHAB.,LLC
Entity Type:Organization
Organization Name:WEST ALLIS CHIROPRACTIC & REHAB.,LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:DAVID
Authorized Official - Last Name:TREMBA
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:414-328-9911
Mailing Address - Street 1:8314 W LINCOLN AVE
Mailing Address - Street 2:
Mailing Address - City:WEST ALLIS
Mailing Address - State:WI
Mailing Address - Zip Code:53219-1763
Mailing Address - Country:US
Mailing Address - Phone:414-328-9911
Mailing Address - Fax:414-328-9944
Practice Address - Street 1:8314 W LINCOLN AVE
Practice Address - Street 2:
Practice Address - City:WEST ALLIS
Practice Address - State:WI
Practice Address - Zip Code:53219-1763
Practice Address - Country:US
Practice Address - Phone:414-328-9911
Practice Address - Fax:414-328-9944
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-26
Last Update Date:2007-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI3837-012111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty