Provider Demographics
NPI:1548427024
Name:PAPENDIECK CHIROPRACTIC
Entity Type:Organization
Organization Name:PAPENDIECK CHIROPRACTIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:ZACHARY
Authorized Official - Middle Name:P
Authorized Official - Last Name:PAPENDIECK
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:920-886-1111
Mailing Address - Street 1:835 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:NEENAH
Mailing Address - State:WI
Mailing Address - Zip Code:54956-2254
Mailing Address - Country:US
Mailing Address - Phone:920-886-1111
Mailing Address - Fax:920-727-1458
Practice Address - Street 1:835 MAIN ST
Practice Address - Street 2:
Practice Address - City:NEENAH
Practice Address - State:WI
Practice Address - Zip Code:54956-2254
Practice Address - Country:US
Practice Address - Phone:920-886-1111
Practice Address - Fax:920-727-1458
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-21
Last Update Date:2008-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI4405-12305R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305R00000XManaged Care OrganizationsPreferred Provider Organization