Provider Demographics
NPI:1558428268
Name:SCOTT A HENRICHS
Entity Type:Organization
Organization Name:SCOTT A HENRICHS
Other - Org Name:TIMBER LAND CHIROPRACTIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DOCTOR OFFICE MGR
Authorized Official - Prefix:
Authorized Official - First Name:WENDY
Authorized Official - Middle Name:M
Authorized Official - Last Name:HENRICHS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:715-362-4852
Mailing Address - Street 1:1 E COURTNEY ST
Mailing Address - Street 2:
Mailing Address - City:RHINELANDER
Mailing Address - State:WI
Mailing Address - Zip Code:54501
Mailing Address - Country:US
Mailing Address - Phone:715-362-4852
Mailing Address - Fax:715-362-4859
Practice Address - Street 1:1 E COURTNEY ST
Practice Address - Street 2:
Practice Address - City:RHINELANDER
Practice Address - State:WI
Practice Address - Zip Code:54501
Practice Address - Country:US
Practice Address - Phone:715-362-4852
Practice Address - Fax:715-362-4859
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-02
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI3044111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
U47483Medicare UPIN