Provider Demographics
NPI:1598060790
Name:CHIROPRACTIC COMPANY - GERMANTOWN LTD
Entity Type:Organization
Organization Name:CHIROPRACTIC COMPANY - GERMANTOWN LTD
Other - Org Name:CHIROPRACTIC COMPANY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CLINIC DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:BRENDA
Authorized Official - Middle Name:
Authorized Official - Last Name:HOLLAND
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:262-250-1948
Mailing Address - Street 1:W164N11269 SQUIRE DR STE B
Mailing Address - Street 2:
Mailing Address - City:GERMANTOWN
Mailing Address - State:WI
Mailing Address - Zip Code:53022-6017
Mailing Address - Country:US
Mailing Address - Phone:262-250-1948
Mailing Address - Fax:262-250-1004
Practice Address - Street 1:W164N11269 SQUIRE DR STE B
Practice Address - Street 2:
Practice Address - City:GERMANTOWN
Practice Address - State:WI
Practice Address - Zip Code:53022-6017
Practice Address - Country:US
Practice Address - Phone:262-250-1948
Practice Address - Fax:262-250-1004
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CHIROPRACTIC COMPANY, S.C.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2011-01-19
Last Update Date:2020-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI4044111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty