Provider Demographics
NPI:1578629424
Name:ADVANCED CHIROPRACTIC, S.C.
Entity Type:Organization
Organization Name:ADVANCED CHIROPRACTIC, S.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:PATRICIA
Authorized Official - Middle Name:E
Authorized Official - Last Name:MARSDEN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:262-877-2196
Mailing Address - Street 1:237 E MAIN ST
Mailing Address - Street 2:PO BOX 130
Mailing Address - City:TWIN LAKES
Mailing Address - State:WI
Mailing Address - Zip Code:53181-9681
Mailing Address - Country:US
Mailing Address - Phone:262-877-2196
Mailing Address - Fax:
Practice Address - Street 1:237 E MAIN ST
Practice Address - Street 2:
Practice Address - City:TWIN LAKES
Practice Address - State:WI
Practice Address - Zip Code:53181-9681
Practice Address - Country:US
Practice Address - Phone:262-877-2196
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-28
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2331-012111NX0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NX0800XChiropractic ProvidersChiropractorOrthopedicGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI38838300Medicaid