Provider Demographics
NPI:1508040197
Name:BARTELS CHIROPRACTIC OFFICE SC
Entity Type:Organization
Organization Name:BARTELS CHIROPRACTIC OFFICE SC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:INGOLF
Authorized Official - Middle Name:K
Authorized Official - Last Name:BARTELS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:920-452-7600
Mailing Address - Street 1:2640 N 8TH STREET
Mailing Address - Street 2:
Mailing Address - City:SHEBOYGAN
Mailing Address - State:WI
Mailing Address - Zip Code:53083-4921
Mailing Address - Country:US
Mailing Address - Phone:920-452-7600
Mailing Address - Fax:920-452-8270
Practice Address - Street 1:2640 N 8TH STREET
Practice Address - Street 2:
Practice Address - City:SHEBOYGAN
Practice Address - State:WI
Practice Address - Zip Code:53083-4921
Practice Address - Country:US
Practice Address - Phone:920-452-7600
Practice Address - Fax:920-452-8270
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-19
Last Update Date:2008-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1389-012111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI395425842006OtherBLUE CROSS BLUE SHIELD
WI395425842006OtherBLUE CROSS BLUE SHIELD