Provider Demographics
NPI:1720009806
Name:CHIROPRACTIC COMPANY S.C.
Entity Type:Organization
Organization Name:CHIROPRACTIC COMPANY S.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINIC DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:CHRISTOPHER
Authorized Official - Last Name:NEMETZ
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:262-782-2273
Mailing Address - Street 1:17550 W BLUEMOUND RD
Mailing Address - Street 2:SUITE 210
Mailing Address - City:BROOKFIELD
Mailing Address - State:WI
Mailing Address - Zip Code:53045-2928
Mailing Address - Country:US
Mailing Address - Phone:262-782-2273
Mailing Address - Fax:262-782-6946
Practice Address - Street 1:17550 W BLUEMOUND RD
Practice Address - Street 2:SUITE 210
Practice Address - City:BROOKFIELD
Practice Address - State:WI
Practice Address - Zip Code:53045-2928
Practice Address - Country:US
Practice Address - Phone:262-782-2273
Practice Address - Fax:262-782-6946
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-22
Last Update Date:2010-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI3397-012111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI38950000Medicaid
WI38950000Medicaid