Provider Demographics
NPI:1548598352
Name:WALWORTH COUNTY CHIROPRACTIC
Entity Type:Organization
Organization Name:WALWORTH COUNTY CHIROPRACTIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:FRED
Authorized Official - Middle Name:D
Authorized Official - Last Name:HELLER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:920-604-1886
Mailing Address - Street 1:517 CALDWELL AVE
Mailing Address - Street 2:
Mailing Address - City:OCONTO FALLS
Mailing Address - State:WI
Mailing Address - Zip Code:54154-1139
Mailing Address - Country:US
Mailing Address - Phone:920-846-3778
Mailing Address - Fax:920-846-3877
Practice Address - Street 1:1221 PHOENIX ST
Practice Address - Street 2:
Practice Address - City:DELAVAN
Practice Address - State:WI
Practice Address - Zip Code:53115-2340
Practice Address - Country:US
Practice Address - Phone:262-728-8208
Practice Address - Fax:262-728-9818
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-12-07
Last Update Date:2010-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI3043-012111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty