Provider Demographics
NPI:1760670012
Name:CROIXVIEW FAMILY CHIROPRACTIC LLC
Entity Type:Organization
Organization Name:CROIXVIEW FAMILY CHIROPRACTIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR OF CHIROPRACTIC
Authorized Official - Prefix:
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:
Authorized Official - Last Name:KROHN-SHUPE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:715-381-9965
Mailing Address - Street 1:113 SECOND ST.
Mailing Address - Street 2:
Mailing Address - City:HUDSON
Mailing Address - State:WI
Mailing Address - Zip Code:54016-1503
Mailing Address - Country:US
Mailing Address - Phone:715-381-9965
Mailing Address - Fax:715-381-9963
Practice Address - Street 1:113 SECOND ST.
Practice Address - Street 2:
Practice Address - City:HUDSON
Practice Address - State:WI
Practice Address - Zip Code:54016-1503
Practice Address - Country:US
Practice Address - Phone:715-381-9965
Practice Address - Fax:715-381-9963
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-11
Last Update Date:2012-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI110466111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI000035847Medicare PIN