Provider Demographics
NPI:1457306375
Name:JUNEAU CHIROPRACTIC CENTER
Entity Type:Organization
Organization Name:JUNEAU CHIROPRACTIC CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:ANDERSON
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:920-386-2822
Mailing Address - Street 1:170 S WESTERN AVE
Mailing Address - Street 2:
Mailing Address - City:JUNEAU
Mailing Address - State:WI
Mailing Address - Zip Code:53039-1161
Mailing Address - Country:US
Mailing Address - Phone:920-386-2822
Mailing Address - Fax:920-386-2862
Practice Address - Street 1:170 S WESTERN AVE
Practice Address - Street 2:
Practice Address - City:JUNEAU
Practice Address - State:WI
Practice Address - Zip Code:53039-1161
Practice Address - Country:US
Practice Address - Phone:920-386-2822
Practice Address - Fax:920-386-2862
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-23
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI3963-012111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI70915Medicare ID - Type UnspecifiedMEDICARE ID NUMBER