Provider Demographics
NPI:1679785729
Name:TWIT CHIROPRACTIC CLINIC, S.C.
Entity Type:Organization
Organization Name:TWIT CHIROPRACTIC CLINIC, S.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JEAN
Authorized Official - Middle Name:
Authorized Official - Last Name:COLOMBE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:715-341-8222
Mailing Address - Street 1:3125 MAIN STREET
Mailing Address - Street 2:
Mailing Address - City:STEVENS POINT
Mailing Address - State:WI
Mailing Address - Zip Code:54481
Mailing Address - Country:US
Mailing Address - Phone:715-341-8222
Mailing Address - Fax:715-341-3663
Practice Address - Street 1:3125 MAIN STREET
Practice Address - Street 2:
Practice Address - City:STEVENS POINT
Practice Address - State:WI
Practice Address - Zip Code:54481
Practice Address - Country:US
Practice Address - Phone:715-341-8222
Practice Address - Fax:715-341-3663
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-03
Last Update Date:2020-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1388111NS0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NS0005XChiropractic ProvidersChiropractorSports PhysicianGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI38825600Medicaid
$$$$$$$$$OtherSOCIAL SECURITY
WV000075226OtherGROUP
WI1388OtherSTATE LICENSE
WI000275226Medicare ID - Type Unspecified
WV000075226OtherGROUP