Provider Demographics
NPI:1669037602
Name:MIDWEST CHIROPRACTIC NEUROLOGY, LLC
Entity Type:Organization
Organization Name:MIDWEST CHIROPRACTIC NEUROLOGY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CONTROLLING MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:DREW
Authorized Official - Middle Name:DAVID
Authorized Official - Last Name:GINTNER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:470-334-4191
Mailing Address - Street 1:2829 COUNTY HIGHWAY I # 3C
Mailing Address - Street 2:
Mailing Address - City:CHIPPEWA FALLS
Mailing Address - State:WI
Mailing Address - Zip Code:54729-2652
Mailing Address - Country:US
Mailing Address - Phone:470-334-4191
Mailing Address - Fax:
Practice Address - Street 1:2829 COUNTY HIGHWAY I # 3C
Practice Address - Street 2:
Practice Address - City:CHIPPEWA FALLS
Practice Address - State:WI
Practice Address - Zip Code:54729-2652
Practice Address - Country:US
Practice Address - Phone:470-334-4191
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-05-06
Last Update Date:2019-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty