Provider Demographics
NPI:1598136012
Name:KRISIK CHIROPRACTIC LLC
Entity Type:Organization
Organization Name:KRISIK CHIROPRACTIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR OF CHIROPRACTIC
Authorized Official - Prefix:
Authorized Official - First Name:AARON
Authorized Official - Middle Name:J
Authorized Official - Last Name:KRISIK
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:715-234-6338
Mailing Address - Street 1:3011 S MAIN ST
Mailing Address - Street 2:SUITE 2
Mailing Address - City:RICE LAKE
Mailing Address - State:WI
Mailing Address - Zip Code:54868-8710
Mailing Address - Country:US
Mailing Address - Phone:715-234-6338
Mailing Address - Fax:
Practice Address - Street 1:3011 S MAIN ST
Practice Address - Street 2:SUITE 2
Practice Address - City:RICE LAKE
Practice Address - State:WI
Practice Address - Zip Code:54868-8710
Practice Address - Country:US
Practice Address - Phone:715-234-6338
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-10-09
Last Update Date:2016-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI4509-12111NN1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NN1001XChiropractic ProvidersChiropractorNutritionGroup - Single Specialty