Provider Demographics
NPI:1558402024
Name:CHIROPRACTIC CARE CENTERS, S.C.
Entity Type:Organization
Organization Name:CHIROPRACTIC CARE CENTERS, S.C.
Other - Org Name:CHIROPRACTIC CARE CENTER - HARTLAND
Other - Org Type:Doing Business As
Authorized Official - Title/Position:BUSINESS MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:RHYS
Authorized Official - Middle Name:
Authorized Official - Last Name:MAROHN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:920-467-4384
Mailing Address - Street 1:864 ROSE DR
Mailing Address - Street 2:
Mailing Address - City:HARTLAND
Mailing Address - State:WI
Mailing Address - Zip Code:53029-8317
Mailing Address - Country:US
Mailing Address - Phone:262-367-4523
Mailing Address - Fax:262-367-4657
Practice Address - Street 1:864 ROSE DR
Practice Address - Street 2:
Practice Address - City:HARTLAND
Practice Address - State:WI
Practice Address - Zip Code:53029-8317
Practice Address - Country:US
Practice Address - Phone:262-367-4523
Practice Address - Fax:262-367-4657
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-09
Last Update Date:2013-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI000035582Medicare ID - Type UnspecifiedMEDICARE GROUP NUMBER