Provider Demographics
NPI:1467682716
Name:MUELLER CHIROPRACTIC, LLC
Entity Type:Organization
Organization Name:MUELLER CHIROPRACTIC, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER/MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:GARY
Authorized Official - Middle Name:L
Authorized Official - Last Name:MUELLER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:715-536-3155
Mailing Address - Street 1:706 S CENTER AVE
Mailing Address - Street 2:
Mailing Address - City:MERRILL
Mailing Address - State:WI
Mailing Address - Zip Code:54452-3405
Mailing Address - Country:US
Mailing Address - Phone:715-536-3155
Mailing Address - Fax:715-536-3155
Practice Address - Street 1:706 S CENTER AVE
Practice Address - Street 2:
Practice Address - City:MERRILL
Practice Address - State:WI
Practice Address - Zip Code:54452-3405
Practice Address - Country:US
Practice Address - Phone:715-536-3155
Practice Address - Fax:715-536-3155
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-07-21
Last Update Date:2009-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1399261QH0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI38751100Medicaid
WI0000075565Medicare NSC
WI38751100Medicaid