Provider Demographics
NPI:1568658912
Name:MIDWEST SPINAL AID CENTERS, LLC
Entity Type:Organization
Organization Name:MIDWEST SPINAL AID CENTERS, LLC
Other - Org Name:SPINAL AID CENTERS OF AMERICA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CO-OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ADAM
Authorized Official - Middle Name:
Authorized Official - Last Name:DUNHAM
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:715-381-5400
Mailing Address - Street 1:400 2ND ST S
Mailing Address - Street 2:SUITE 270
Mailing Address - City:HUDSON
Mailing Address - State:WI
Mailing Address - Zip Code:54016-4000
Mailing Address - Country:US
Mailing Address - Phone:715-381-5400
Mailing Address - Fax:
Practice Address - Street 1:400 2ND ST S
Practice Address - Street 2:SUITE 270
Practice Address - City:HUDSON
Practice Address - State:WI
Practice Address - Zip Code:54016-4000
Practice Address - Country:US
Practice Address - Phone:715-381-5400
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-19
Last Update Date:2007-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI4043-012111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty