Provider Demographics
NPI:1790080984
Name:CHIROPRACTIC COMPANY - MILWAUKEE EAST LTD.
Entity Type:Organization
Organization Name:CHIROPRACTIC COMPANY - MILWAUKEE EAST LTD.
Other - Org Name:CHIROPRACTIC COMPANY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CLINIC DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:KENT
Authorized Official - Middle Name:L
Authorized Official - Last Name:MCLEOD
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:414-223-4550
Mailing Address - Street 1:2332 N FARWELL AVE
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53211-4401
Mailing Address - Country:US
Mailing Address - Phone:414-223-4550
Mailing Address - Fax:414-223-4148
Practice Address - Street 1:2332 N FARWELL AVE
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53211-4401
Practice Address - Country:US
Practice Address - Phone:414-223-4550
Practice Address - Fax:414-223-4148
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CHIROPRACTIC COMPANY, S.C.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2011-01-19
Last Update Date:2011-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI4056111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty