Provider Demographics
NPI:1417327230
Name:CHAIN OF LAKES CHIROPRACTIC LLC
Entity Type:Organization
Organization Name:CHAIN OF LAKES CHIROPRACTIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:NORMAN
Authorized Official - Last Name:SEVERT
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:715-924-3510
Mailing Address - Street 1:112 KNAPP ST
Mailing Address - Street 2:P.O. BOX 558
Mailing Address - City:CHETEK
Mailing Address - State:WI
Mailing Address - Zip Code:54728-4126
Mailing Address - Country:US
Mailing Address - Phone:715-924-3510
Mailing Address - Fax:715-924-1848
Practice Address - Street 1:112 KNAPP ST
Practice Address - Street 2:
Practice Address - City:CHETEK
Practice Address - State:WI
Practice Address - Zip Code:54728-4126
Practice Address - Country:US
Practice Address - Phone:715-924-3510
Practice Address - Fax:715-924-1848
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-10-06
Last Update Date:2015-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI3477-012111NN1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NN1001XChiropractic ProvidersChiropractorNutritionGroup - Single Specialty