Provider Demographics
NPI:1508073800
Name:CHIROPRACTIC CENTER OF MONROE, S.C.
Entity Type:Organization
Organization Name:CHIROPRACTIC CENTER OF MONROE, S.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:DAVID
Authorized Official - Last Name:SPONTAK
Authorized Official - Suffix:
Authorized Official - Credentials:D C
Authorized Official - Phone:608-328-2225
Mailing Address - Street 1:765 10TH AVENUE CT.
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:WI
Mailing Address - Zip Code:53566-1427
Mailing Address - Country:US
Mailing Address - Phone:608-328-2225
Mailing Address - Fax:608-328-2436
Practice Address - Street 1:765 10TH AVENUE CT.
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:WI
Practice Address - Zip Code:53566-1427
Practice Address - Country:US
Practice Address - Phone:608-328-2225
Practice Address - Fax:608-328-2436
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-17
Last Update Date:2012-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2609111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI38848600Medicaid
WIU03119Medicare UPIN
WI70605Medicare ID - Type Unspecified