Provider Demographics
NPI:1609868793
Name:WAUPACA CHIROPRACTIC CENTER, INC.
Entity Type:Organization
Organization Name:WAUPACA CHIROPRACTIC CENTER, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MIRIAM
Authorized Official - Middle Name:JOY
Authorized Official - Last Name:LEEAN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:715-258-8211
Mailing Address - Street 1:700 HILLCREST DR
Mailing Address - Street 2:
Mailing Address - City:WAUPACA
Mailing Address - State:WI
Mailing Address - Zip Code:54981-1410
Mailing Address - Country:US
Mailing Address - Phone:715-258-8211
Mailing Address - Fax:715-258-0118
Practice Address - Street 1:700 HILLCREST DR
Practice Address - Street 2:
Practice Address - City:WAUPACA
Practice Address - State:WI
Practice Address - Zip Code:54981-1410
Practice Address - Country:US
Practice Address - Phone:715-258-8211
Practice Address - Fax:715-258-0118
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-16
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI3651-012111N00000X
WI2695111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI38934000Medicaid
WIU80350Medicare UPIN