Provider Demographics
NPI:1477724276
Name:WASHA CHIROPRACTIC CLINIC, INC.
Entity Type:Organization
Organization Name:WASHA CHIROPRACTIC CLINIC, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:M
Authorized Official - Last Name:WASHA
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:608-785-7746
Mailing Address - Street 1:1415 HWY 16
Mailing Address - Street 2:
Mailing Address - City:LA CROSSE
Mailing Address - State:WI
Mailing Address - Zip Code:54601
Mailing Address - Country:US
Mailing Address - Phone:608-785-7746
Mailing Address - Fax:608-782-2938
Practice Address - Street 1:1415 STATE ROAD 16
Practice Address - Street 2:
Practice Address - City:LA CROSSE
Practice Address - State:WI
Practice Address - Zip Code:54601-2980
Practice Address - Country:US
Practice Address - Phone:608-785-7746
Practice Address - Fax:608-782-2938
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-19
Last Update Date:2012-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2535111NS0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NS0005XChiropractic ProvidersChiropractorSports PhysicianGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GADH2322OtherRAILROAD MEDICARE
MN3J348WAOtherBLUE CROSS BLUE SHIELD
WI000070231Medicare PIN
WI000070231Medicare UPIN