Provider Demographics
NPI:1518036615
Name:HOFFMAN CHIROPRACTIC L.L.C.
Entity Type:Organization
Organization Name:HOFFMAN CHIROPRACTIC L.L.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:GLENN
Authorized Official - Middle Name:JOHN
Authorized Official - Last Name:HOFFMAN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:920-498-3611
Mailing Address - Street 1:1841 S RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:GREEN BAY
Mailing Address - State:WI
Mailing Address - Zip Code:54304-3938
Mailing Address - Country:US
Mailing Address - Phone:920-498-3611
Mailing Address - Fax:920-498-3611
Practice Address - Street 1:1841 S RIDGE RD
Practice Address - Street 2:
Practice Address - City:GREEN BAY
Practice Address - State:WI
Practice Address - Zip Code:54304-3938
Practice Address - Country:US
Practice Address - Phone:920-498-3611
Practice Address - Fax:920-498-3611
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-06
Last Update Date:2011-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1698-012111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI000075600Medicare ID - Type UnspecifiedPROVIDER NUMBER
WIT62231Medicare UPIN