Provider Demographics
NPI:1568616175
Name:CLINTONVILLE CHIROPRACTIC,INC.
Entity Type:Organization
Organization Name:CLINTONVILLE CHIROPRACTIC,INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CHRIS
Authorized Official - Middle Name:TODD
Authorized Official - Last Name:KRUEGER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:715-823-2121
Mailing Address - Street 1:E9180 GOLF CLUB RD
Mailing Address - Street 2:
Mailing Address - City:CLINTONVILLE
Mailing Address - State:WI
Mailing Address - Zip Code:54929-9016
Mailing Address - Country:US
Mailing Address - Phone:715-823-2121
Mailing Address - Fax:715-823-5969
Practice Address - Street 1:E9180 GOLF CLUB RD
Practice Address - Street 2:
Practice Address - City:CLINTONVILLE
Practice Address - State:WI
Practice Address - Zip Code:54929-9016
Practice Address - Country:US
Practice Address - Phone:715-823-2121
Practice Address - Fax:715-823-5969
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-11-10
Last Update Date:2008-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI3374111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty