Provider Demographics
NPI:1457020323
Name:MEQUON FAMILY CHIROPRACTIC LLC
Entity Type:Organization
Organization Name:MEQUON FAMILY CHIROPRACTIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:BRITTANY
Authorized Official - Middle Name:WOLFMEYER
Authorized Official - Last Name:IGWIKE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:414-364-0833
Mailing Address - Street 1:6617 W MEQUON RD UNIT A
Mailing Address - Street 2:
Mailing Address - City:MEQUON
Mailing Address - State:WI
Mailing Address - Zip Code:53092-1834
Mailing Address - Country:US
Mailing Address - Phone:262-444-3545
Mailing Address - Fax:
Practice Address - Street 1:6617 W MEQUON RD UNIT A
Practice Address - Street 2:
Practice Address - City:MEQUON
Practice Address - State:WI
Practice Address - Zip Code:53092-1834
Practice Address - Country:US
Practice Address - Phone:262-444-3545
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-09-13
Last Update Date:2021-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty