Provider Demographics
NPI:1477704542
Name:FELICIJAN CHIROPRACTIC, INC.
Entity Type:Organization
Organization Name:FELICIJAN CHIROPRACTIC, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:J
Authorized Official - Last Name:FELICIJAN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:608-429-3323
Mailing Address - Street 1:124 2ND ST
Mailing Address - Street 2:
Mailing Address - City:PARDEEVILLE
Mailing Address - State:WI
Mailing Address - Zip Code:53954-8826
Mailing Address - Country:US
Mailing Address - Phone:608-429-3323
Mailing Address - Fax:608-429-4828
Practice Address - Street 1:124 2ND ST
Practice Address - Street 2:
Practice Address - City:PARDEEVILLE
Practice Address - State:WI
Practice Address - Zip Code:53954-8826
Practice Address - Country:US
Practice Address - Phone:608-429-3323
Practice Address - Fax:608-429-4828
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-07
Last Update Date:2008-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2333-012261QM2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WIT95281Medicare UPIN