Provider Demographics
NPI:1558826560
Name:NORTHERN DOOR CHIROPRACTIC AND WELLNESS LLC
Entity Type:Organization
Organization Name:NORTHERN DOOR CHIROPRACTIC AND WELLNESS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:EDWIN
Authorized Official - Last Name:MORLEY
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:920-216-6924
Mailing Address - Street 1:10590 COUNTRY WALK DR UNIT 2
Mailing Address - Street 2:
Mailing Address - City:SISTER BAY
Mailing Address - State:WI
Mailing Address - Zip Code:54234-9103
Mailing Address - Country:US
Mailing Address - Phone:920-633-4055
Mailing Address - Fax:
Practice Address - Street 1:10590 COUNTRY WALK DR UNIT 2
Practice Address - Street 2:
Practice Address - City:SISTER BAY
Practice Address - State:WI
Practice Address - Zip Code:54234-9103
Practice Address - Country:US
Practice Address - Phone:920-633-4055
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-02-04
Last Update Date:2019-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty