Provider Demographics
NPI:1497937122
Name:FAMILY CHIROPRACTIC CLINIC
Entity Type:Organization
Organization Name:FAMILY CHIROPRACTIC CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:GRANT
Authorized Official - Last Name:SCHOENENBERGER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:608-754-4216
Mailing Address - Street 1:1215 BLACK BRIDGE RD
Mailing Address - Street 2:
Mailing Address - City:JANESVILLE
Mailing Address - State:WI
Mailing Address - Zip Code:53545-0891
Mailing Address - Country:US
Mailing Address - Phone:608-754-4216
Mailing Address - Fax:608-754-2742
Practice Address - Street 1:1215 BLACK BRIDGE RD
Practice Address - Street 2:
Practice Address - City:JANESVILLE
Practice Address - State:WI
Practice Address - Zip Code:53545-0891
Practice Address - Country:US
Practice Address - Phone:608-754-4216
Practice Address - Fax:608-754-2742
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-05
Last Update Date:2008-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2516-012111NR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NR0400XChiropractic ProvidersChiropractorRehabilitationGroup - Single Specialty