Provider Demographics
NPI:1710221908
Name:CENTER OF CHIROPRACTIC NEUROLOGY INC
Entity Type:Organization
Organization Name:CENTER OF CHIROPRACTIC NEUROLOGY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:DONALD
Authorized Official - Middle Name:JOSEPH
Authorized Official - Last Name:PFAU
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:608-370-7328
Mailing Address - Street 1:620 JACKSON ST
Mailing Address - Street 2:
Mailing Address - City:SAUK CITY
Mailing Address - State:WI
Mailing Address - Zip Code:53583-1463
Mailing Address - Country:US
Mailing Address - Phone:608-370-7328
Mailing Address - Fax:608-237-3119
Practice Address - Street 1:620 JACKSON ST
Practice Address - Street 2:
Practice Address - City:SAUK CITY
Practice Address - State:WI
Practice Address - Zip Code:53583-1463
Practice Address - Country:US
Practice Address - Phone:608-370-7328
Practice Address - Fax:608-237-3119
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-11-12
Last Update Date:2015-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI4222-012111NN0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NN0400XChiropractic ProvidersChiropractorNeurologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI1174578942Medicaid