Provider Demographics
NPI:1760632525
Name:CHIROPRACTIC CARE CENTER - RACINE SC
Entity Type:Organization
Organization Name:CHIROPRACTIC CARE CENTER - RACINE SC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:E
Authorized Official - Last Name:OKLAND
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:262-321-0208
Mailing Address - Street 1:6218 WASHINGTON AVE STE A
Mailing Address - Street 2:
Mailing Address - City:RACINE
Mailing Address - State:WI
Mailing Address - Zip Code:53406-3916
Mailing Address - Country:US
Mailing Address - Phone:262-321-0208
Mailing Address - Fax:262-321-0210
Practice Address - Street 1:6218 WASHINGTON AVE STE A
Practice Address - Street 2:
Practice Address - City:RACINE
Practice Address - State:WI
Practice Address - Zip Code:53406-3916
Practice Address - Country:US
Practice Address - Phone:262-321-0208
Practice Address - Fax:262-321-0210
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-09-29
Last Update Date:2008-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2858-012111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty