Provider Demographics
NPI:1629356621
Name:CHIROPRACTIC SOLUTIONS INC
Entity Type:Organization
Organization Name:CHIROPRACTIC SOLUTIONS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MATT
Authorized Official - Middle Name:
Authorized Official - Last Name:KINGSTON
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:608-497-1161
Mailing Address - Street 1:3187 MUIR FIELD RD
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:WI
Mailing Address - Zip Code:53719-2508
Mailing Address - Country:US
Mailing Address - Phone:608-497-1161
Mailing Address - Fax:608-497-1181
Practice Address - Street 1:3187 MUIR FIELD RD
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53719-2508
Practice Address - Country:US
Practice Address - Phone:608-497-1161
Practice Address - Fax:608-497-1181
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-07-26
Last Update Date:2011-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI4500-12111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WIWI1416Medicare PIN