Provider Demographics
NPI:1477727931
Name:WEST SALEM CHIROPRACTIC CLINIC, INC.
Entity Type:Organization
Organization Name:WEST SALEM CHIROPRACTIC CLINIC, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:JOSEPH
Authorized Official - Last Name:EORIATTI
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:608-786-3304
Mailing Address - Street 1:640 COMMERCE ST
Mailing Address - Street 2:
Mailing Address - City:WEST SALEM
Mailing Address - State:WI
Mailing Address - Zip Code:54669-1179
Mailing Address - Country:US
Mailing Address - Phone:608-786-3304
Mailing Address - Fax:608-786-4574
Practice Address - Street 1:640 COMMERCE ST
Practice Address - Street 2:
Practice Address - City:WEST SALEM
Practice Address - State:WI
Practice Address - Zip Code:54669-1179
Practice Address - Country:US
Practice Address - Phone:608-786-3304
Practice Address - Fax:608-786-4574
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-16
Last Update Date:2008-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI3409-012261QH0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI38930300Medicaid
WI38930300Medicaid
WI000035738Medicare PIN