Provider Demographics
NPI:1467655563
Name:EMMERICH CHIROPRACTIC CLINIC SC
Entity Type:Organization
Organization Name:EMMERICH CHIROPRACTIC CLINIC SC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:P
Authorized Official - Last Name:EMMERICH
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:608-833-2333
Mailing Address - Street 1:6506 NORMANDY LN
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:WI
Mailing Address - Zip Code:53719-1037
Mailing Address - Country:US
Mailing Address - Phone:608-833-2333
Mailing Address - Fax:
Practice Address - Street 1:6506 NORMANDY LN
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53719-1037
Practice Address - Country:US
Practice Address - Phone:608-833-2333
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-06
Last Update Date:2019-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1642012111N00000X
WI3167-012111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WIT61857Medicare UPIN
WI35490Medicare ID - Type UnspecifiedCHIROPRACTIC