Provider Demographics
NPI:1679616148
Name:ADVANTAGE CHIROPRACTIC CLINIC OF GREEN BAY, S.C.
Entity Type:Organization
Organization Name:ADVANTAGE CHIROPRACTIC CLINIC OF GREEN BAY, S.C.
Other - Org Name:METZLER & RAIHALA CHIROPRACTIC CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CHERYL
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:METZLER
Authorized Official - Suffix:
Authorized Official - Credentials:DC, DABCI
Authorized Official - Phone:920-432-7774
Mailing Address - Street 1:1804 S ASHLAND AVE
Mailing Address - Street 2:
Mailing Address - City:GREEN BAY
Mailing Address - State:WI
Mailing Address - Zip Code:54304-3702
Mailing Address - Country:US
Mailing Address - Phone:920-432-7774
Mailing Address - Fax:920-432-7784
Practice Address - Street 1:1804 S ASHLAND AVE
Practice Address - Street 2:
Practice Address - City:GREEN BAY
Practice Address - State:WI
Practice Address - Zip Code:54304-3702
Practice Address - Country:US
Practice Address - Phone:920-432-7774
Practice Address - Fax:920-432-7784
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-15
Last Update Date:2012-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WIDD1169OtherRAILROAD GROUP NUMBER
WI3917553140OtherBCBS NUMBER
WIDD1169OtherRAILROAD GROUP NUMBER