Provider Demographics
NPI:1598952459
Name:NEW LEAF CHIROPRACTIC INC
Entity Type:Organization
Organization Name:NEW LEAF CHIROPRACTIC INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:PETER
Authorized Official - Middle Name:
Authorized Official - Last Name:SCHMITT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:608-328-1220
Mailing Address - Street 1:301 6TH AVE W STE 103
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:WI
Mailing Address - Zip Code:53566-1389
Mailing Address - Country:US
Mailing Address - Phone:608-328-1220
Mailing Address - Fax:608-328-1221
Practice Address - Street 1:301 6TH AVE W STE 103
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:WI
Practice Address - Zip Code:53566-1389
Practice Address - Country:US
Practice Address - Phone:608-328-1220
Practice Address - Fax:608-328-1221
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-25
Last Update Date:2010-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI4063-012111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
000025015Medicare PIN