Provider Demographics
NPI:1477587681
Name:NORTHEAST WISCONSIN SPINE CENTERS
Entity Type:Organization
Organization Name:NORTHEAST WISCONSIN SPINE CENTERS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSHUA
Authorized Official - Middle Name:JAMES
Authorized Official - Last Name:HEIMERL
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:920-803-2225
Mailing Address - Street 1:1720 N 8TH ST
Mailing Address - Street 2:
Mailing Address - City:SHEBOYGAN
Mailing Address - State:WI
Mailing Address - Zip Code:53081-2773
Mailing Address - Country:US
Mailing Address - Phone:920-803-2225
Mailing Address - Fax:920-803-3001
Practice Address - Street 1:1720 N 8TH ST
Practice Address - Street 2:
Practice Address - City:SHEBOYGAN
Practice Address - State:WI
Practice Address - Zip Code:53081-2773
Practice Address - Country:US
Practice Address - Phone:920-803-2225
Practice Address - Fax:920-803-3001
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-11
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty