Provider Demographics
NPI:1699177543
Name:SHOOK FAMILY CHIROPRACTIC, LLC
Entity Type:Organization
Organization Name:SHOOK FAMILY CHIROPRACTIC, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR OF CHIROPRACTIC/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ERIN
Authorized Official - Middle Name:
Authorized Official - Last Name:SHOOK
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:608-498-3746
Mailing Address - Street 1:125570 BALSAM RD
Mailing Address - Street 2:
Mailing Address - City:STRATFORD
Mailing Address - State:WI
Mailing Address - Zip Code:54484
Mailing Address - Country:US
Mailing Address - Phone:608-498-3746
Mailing Address - Fax:
Practice Address - Street 1:125570 BALSAM RD
Practice Address - Street 2:
Practice Address - City:STRATFORD
Practice Address - State:WI
Practice Address - Zip Code:54484
Practice Address - Country:US
Practice Address - Phone:608-498-3746
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-09-23
Last Update Date:2019-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI4887-12111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty