Provider Demographics
NPI:1720418791
Name:RIVERWEST CHIROPRACTIC CENTER LLC
Entity Type:Organization
Organization Name:RIVERWEST CHIROPRACTIC CENTER LLC
Other - Org Name:FRONT RUNNER CHIROPRACTIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BETH
Authorized Official - Middle Name:NOEL
Authorized Official - Last Name:RINGWELSKI
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:414-263-7066
Mailing Address - Street 1:7606 HARWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:WAUWATOSA
Mailing Address - State:WI
Mailing Address - Zip Code:53213-2609
Mailing Address - Country:US
Mailing Address - Phone:414-263-3066
Mailing Address - Fax:414-263-3066
Practice Address - Street 1:7606 HARWOOD AVE
Practice Address - Street 2:
Practice Address - City:WAUWATOSA
Practice Address - State:WI
Practice Address - Zip Code:53213-2609
Practice Address - Country:US
Practice Address - Phone:414-263-3066
Practice Address - Fax:414-263-3066
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-11-12
Last Update Date:2020-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI4709-012111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI1457655656Medicaid
WI1457655656OtherINSURER