Provider Demographics
NPI:1497050348
Name:MARTIN E. MYTAS D.C.,S.C.
Entity Type:Organization
Organization Name:MARTIN E. MYTAS D.C.,S.C.
Other - Org Name:THRIVE WELLNESS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MARTIN
Authorized Official - Middle Name:
Authorized Official - Last Name:MYTAS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:608-487-2171
Mailing Address - Street 1:1103 FRONT ST.
Mailing Address - Street 2:
Mailing Address - City:CASHTON
Mailing Address - State:WI
Mailing Address - Zip Code:54619
Mailing Address - Country:US
Mailing Address - Phone:608-654-5200
Mailing Address - Fax:608-654-5140
Practice Address - Street 1:1103 FRONT ST.
Practice Address - Street 2:
Practice Address - City:CASHTON
Practice Address - State:WI
Practice Address - Zip Code:54619
Practice Address - Country:US
Practice Address - Phone:608-654-5200
Practice Address - Fax:608-654-5140
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-01-24
Last Update Date:2011-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI4213-012111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty