Provider Demographics
NPI:1427181106
Name:CHIROPRACTIC COMPANY - CUDAHY LTD
Entity Type:Organization
Organization Name:CHIROPRACTIC COMPANY - CUDAHY LTD
Other - Org Name:CHIROPRACTIC COMPANY - CUDAHY LTD
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:PAUL
Authorized Official - Last Name:CORSI
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:144-354-5377
Mailing Address - Street 1:3552 E BARNARD AVE
Mailing Address - Street 2:
Mailing Address - City:CUDAHY
Mailing Address - State:WI
Mailing Address - Zip Code:53110-1602
Mailing Address - Country:US
Mailing Address - Phone:414-483-4800
Mailing Address - Fax:262-421-2773
Practice Address - Street 1:3552 E BARNARD AVE
Practice Address - Street 2:
Practice Address - City:CUDAHY
Practice Address - State:WI
Practice Address - Zip Code:53110-1602
Practice Address - Country:US
Practice Address - Phone:414-483-4800
Practice Address - Fax:414-483-0555
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CHIROPRACTIC COMPANY S.C.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-03-13
Last Update Date:2023-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI3448-012111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WIU69050Medicare UPIN