Provider Demographics
NPI:1427004803
Name:ULREY CHIROPRACTIC OFFICE SC
Entity Type:Organization
Organization Name:ULREY CHIROPRACTIC OFFICE SC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:SAM
Authorized Official - Middle Name:J
Authorized Official - Last Name:RIEDL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:920-261-0855
Mailing Address - Street 1:303 S 1ST ST
Mailing Address - Street 2:
Mailing Address - City:WATERTOWN
Mailing Address - State:WI
Mailing Address - Zip Code:53094-4405
Mailing Address - Country:US
Mailing Address - Phone:920-261-0855
Mailing Address - Fax:920-261-0940
Practice Address - Street 1:303 S 1ST ST
Practice Address - Street 2:
Practice Address - City:WATERTOWN
Practice Address - State:WI
Practice Address - Zip Code:53094-4405
Practice Address - Country:US
Practice Address - Phone:920-261-0855
Practice Address - Fax:920-261-0940
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-26
Last Update Date:2008-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1440111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI1366441453OtherINDIVIDUAL NPI
WI38760900Medicaid
WI=========OtherTAX ID
WI38760900Medicaid