Provider Demographics
NPI:1477742344
Name:GOLDE CHIROPRACTIC CENTER SC
Entity Type:Organization
Organization Name:GOLDE CHIROPRACTIC CENTER SC
Other - Org Name:CHIROPRACTIC NECK & BACK CARE CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:MITCHELL
Authorized Official - Last Name:CAULDER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:715-832-6145
Mailing Address - Street 1:2403 LONDON ROAD
Mailing Address - Street 2:
Mailing Address - City:EAU CLAIRE
Mailing Address - State:WI
Mailing Address - Zip Code:54701-6731
Mailing Address - Country:US
Mailing Address - Phone:715-832-6145
Mailing Address - Fax:715-832-6136
Practice Address - Street 1:2403 LONDON ROAD
Practice Address - Street 2:
Practice Address - City:EAU CLAIRE
Practice Address - State:WI
Practice Address - Zip Code:54701-6731
Practice Address - Country:US
Practice Address - Phone:715-832-6145
Practice Address - Fax:715-832-6136
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-17
Last Update Date:2007-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI3619111N00000X
MN3555111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI38921900Medicaid
WI38921900Medicaid