Provider Demographics
NPI:1710308564
Name:VANNATTA CHIROPRACTIC
Entity Type:Organization
Organization Name:VANNATTA CHIROPRACTIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/CHIROPRACTOR/AUTHORIZED OFFIC
Authorized Official - Prefix:DR
Authorized Official - First Name:MANDY
Authorized Official - Middle Name:
Authorized Official - Last Name:VANNATTA
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:608-732-5545
Mailing Address - Street 1:430 E MAIN ST.
Mailing Address - Street 2:
Mailing Address - City:PLATTEVILLE
Mailing Address - State:WI
Mailing Address - Zip Code:53818
Mailing Address - Country:US
Mailing Address - Phone:608-732-5545
Mailing Address - Fax:
Practice Address - Street 1:1250 E. BUSINESS HIGHWAY 151
Practice Address - Street 2:SUITE H.
Practice Address - City:PLATTEVILLE
Practice Address - State:WI
Practice Address - Zip Code:53818
Practice Address - Country:US
Practice Address - Phone:608-732-5545
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-12-20
Last Update Date:2023-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI4756-12111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI359800007Medicare PIN