Provider Demographics
NPI:1578747473
Name:SPARTA CHIROPRACTIC CLINIC, LLC
Entity Type:Organization
Organization Name:SPARTA CHIROPRACTIC CLINIC, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CINDY
Authorized Official - Middle Name:L
Authorized Official - Last Name:PUENT
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:608-269-1451
Mailing Address - Street 1:110 W WISCONSIN ST
Mailing Address - Street 2:
Mailing Address - City:SPARTA
Mailing Address - State:WI
Mailing Address - Zip Code:54656-2314
Mailing Address - Country:US
Mailing Address - Phone:608-269-1451
Mailing Address - Fax:608-269-1452
Practice Address - Street 1:110 W WISCONSIN ST
Practice Address - Street 2:
Practice Address - City:SPARTA
Practice Address - State:WI
Practice Address - Zip Code:54656-2314
Practice Address - Country:US
Practice Address - Phone:608-269-1451
Practice Address - Fax:608-269-1452
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-27
Last Update Date:2008-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI3690111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty