Provider Demographics
NPI:1528204682
Name:APPLETON CHIROPRACTIC, INC.
Entity Type:Organization
Organization Name:APPLETON CHIROPRACTIC, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ROY
Authorized Official - Middle Name:
Authorized Official - Last Name:OSTENSON
Authorized Official - Suffix:
Authorized Official - Credentials:BS, DC
Authorized Official - Phone:920-731-0715
Mailing Address - Street 1:2425 W WISCONSIN AVE
Mailing Address - Street 2:
Mailing Address - City:APPLETON
Mailing Address - State:WI
Mailing Address - Zip Code:54914-3110
Mailing Address - Country:US
Mailing Address - Phone:920-731-0715
Mailing Address - Fax:
Practice Address - Street 1:2425 W WISCONSIN AVE
Practice Address - Street 2:
Practice Address - City:APPLETON
Practice Address - State:WI
Practice Address - Zip Code:54914-3110
Practice Address - Country:US
Practice Address - Phone:920-731-0715
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-12-19
Last Update Date:2008-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1369-012261QH0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service
Provider Identifiers
StateIdentifier IDID TypeIssuer
WIT62931Medicare UPIN