Provider Demographics
NPI:1487015723
Name:FLEUCHAUS CHIROPRACTIC CLINIC LLC
Entity Type:Organization
Organization Name:FLEUCHAUS CHIROPRACTIC CLINIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:S
Authorized Official - Last Name:FLEUCHAUS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:414-456-9896
Mailing Address - Street 1:9538 W GREENFIELD AVE
Mailing Address - Street 2:
Mailing Address - City:WEST ALLIS
Mailing Address - State:WI
Mailing Address - Zip Code:53214-2701
Mailing Address - Country:US
Mailing Address - Phone:414-456-9896
Mailing Address - Fax:
Practice Address - Street 1:9538 W GREENFIELD AVE
Practice Address - Street 2:
Practice Address - City:WEST ALLIS
Practice Address - State:WI
Practice Address - Zip Code:53214-2701
Practice Address - Country:US
Practice Address - Phone:414-456-9896
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-03-15
Last Update Date:2016-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2716-012261QH0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI38894300Medicaid
WI70914Medicare PIN
WIU42126Medicare UPIN