Provider Demographics
NPI:1578644068
Name:BBGH PARTNERSHIP
Entity Type:Organization
Organization Name:BBGH PARTNERSHIP
Other - Org Name:COMMUNITY CHIROPRACTIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:BERNICE
Authorized Official - Middle Name:
Authorized Official - Last Name:ELLIOTT
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:262-275-1700
Mailing Address - Street 1:541 KENOSHA ST
Mailing Address - Street 2:
Mailing Address - City:WALWORTH
Mailing Address - State:WI
Mailing Address - Zip Code:53184-9538
Mailing Address - Country:US
Mailing Address - Phone:262-275-1700
Mailing Address - Fax:262-275-8767
Practice Address - Street 1:541 KENOSHA ST
Practice Address - Street 2:
Practice Address - City:WALWORTH
Practice Address - State:WI
Practice Address - Zip Code:53184-9538
Practice Address - Country:US
Practice Address - Phone:262-275-1700
Practice Address - Fax:262-275-8767
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-18
Last Update Date:2007-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI3166-012111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI38927700Medicaid