Provider Demographics
NPI:1710172556
Name:CLINICAL CHIROPRACTIC OF WHITEWATER, S.C.
Entity Type:Organization
Organization Name:CLINICAL CHIROPRACTIC OF WHITEWATER, S.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:RANDALL
Authorized Official - Middle Name:
Authorized Official - Last Name:NODORFT
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:262-472-9115
Mailing Address - Street 1:884 S JANESVILLE ST
Mailing Address - Street 2:STE. C
Mailing Address - City:WHITEWATER
Mailing Address - State:WI
Mailing Address - Zip Code:53190-2516
Mailing Address - Country:US
Mailing Address - Phone:262-472-9115
Mailing Address - Fax:
Practice Address - Street 1:884 S JANESVILLE ST
Practice Address - Street 2:STE. C
Practice Address - City:WHITEWATER
Practice Address - State:WI
Practice Address - Zip Code:53190-2516
Practice Address - Country:US
Practice Address - Phone:262-472-9115
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-13
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty