Provider Demographics
NPI:1508003757
Name:CLEARWATER CHIROPRACTIC LLC
Entity Type:Organization
Organization Name:CLEARWATER CHIROPRACTIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SHAREHOLDER
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:FLOOD
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:715-831-2111
Mailing Address - Street 1:2907 MALL DR
Mailing Address - Street 2:
Mailing Address - City:EAU CLAIRE
Mailing Address - State:WI
Mailing Address - Zip Code:54701-6866
Mailing Address - Country:US
Mailing Address - Phone:715-831-2111
Mailing Address - Fax:715-831-2115
Practice Address - Street 1:2907 MALL DR
Practice Address - Street 2:
Practice Address - City:EAU CLAIRE
Practice Address - State:WI
Practice Address - Zip Code:54701-6866
Practice Address - Country:US
Practice Address - Phone:715-831-2111
Practice Address - Fax:715-831-2115
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-01-09
Last Update Date:2009-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI4229-012111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty