Provider Demographics
NPI:1710040365
Name:WEBLEY CHIROPRACTIC CLINIC, S.C.
Entity Type:Organization
Organization Name:WEBLEY CHIROPRACTIC CLINIC, S.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:D
Authorized Official - Last Name:WEBLEY
Authorized Official - Suffix:JR
Authorized Official - Credentials:DC
Authorized Official - Phone:262-763-6000
Mailing Address - Street 1:1050 MILWAUKEE AVE STE 101
Mailing Address - Street 2:P.O. BOX 698
Mailing Address - City:BURLINGTON
Mailing Address - State:WI
Mailing Address - Zip Code:53105-1362
Mailing Address - Country:US
Mailing Address - Phone:262-763-6000
Mailing Address - Fax:262-763-1886
Practice Address - Street 1:1050 MILWAUKEE AVE
Practice Address - Street 2:SUITE 101
Practice Address - City:BURLINGTON
Practice Address - State:WI
Practice Address - Zip Code:53105-1362
Practice Address - Country:US
Practice Address - Phone:262-763-6000
Practice Address - Fax:262-763-1886
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-18
Last Update Date:2014-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI3283-012111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI38897100Medicaid
WI000035912OtherMEDICARE GROUP UNSPECIFIED
WIU57095Medicare UPIN