Provider Demographics
NPI:1710637731
Name:SHEBOYGAN CHIRO PLUS LLC
Entity Type:Organization
Organization Name:SHEBOYGAN CHIRO PLUS LLC
Other - Org Name:SHEBOYGAN CHIROPRACTIC PLUS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:JORDAN
Authorized Official - Middle Name:L
Authorized Official - Last Name:TEUNISSEN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:920-286-4280
Mailing Address - Street 1:1028B INDIANA AVE
Mailing Address - Street 2:
Mailing Address - City:SHEBOYGAN
Mailing Address - State:WI
Mailing Address - Zip Code:53081-4913
Mailing Address - Country:US
Mailing Address - Phone:920-286-4280
Mailing Address - Fax:
Practice Address - Street 1:2217 S MEMORIAL PL
Practice Address - Street 2:
Practice Address - City:SHEBOYGAN
Practice Address - State:WI
Practice Address - Zip Code:53081-3715
Practice Address - Country:US
Practice Address - Phone:920-286-4280
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-03-24
Last Update Date:2023-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty