Provider Demographics
NPI:1467639849
Name:MCGINNIS CHIROPRACTIC OFFICE INC
Entity Type:Organization
Organization Name:MCGINNIS CHIROPRACTIC OFFICE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:OWEN
Authorized Official - Last Name:MCGINNIS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:920-582-4364
Mailing Address - Street 1:11 N. 6TH AVE
Mailing Address - Street 2:
Mailing Address - City:WINNECONNE
Mailing Address - State:WI
Mailing Address - Zip Code:54986-9705
Mailing Address - Country:US
Mailing Address - Phone:920-582-4364
Mailing Address - Fax:920-582-4004
Practice Address - Street 1:11 N. 6TH AVE
Practice Address - Street 2:
Practice Address - City:WINNECONNE
Practice Address - State:WI
Practice Address - Zip Code:54986-9705
Practice Address - Country:US
Practice Address - Phone:920-582-4364
Practice Address - Fax:920-582-4004
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-28
Last Update Date:2011-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1578012111N00000X
WI1578-012111N00000X
MO005572111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WIT62722Medicare UPIN
WI000075125Medicare PIN