Provider Demographics
NPI:1790896975
Name:CHIROPRACTIC ASSOCIATES OF PLATTEVILLE LLC
Entity Type:Organization
Organization Name:CHIROPRACTIC ASSOCIATES OF PLATTEVILLE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACOR/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:TAMI
Authorized Official - Middle Name:L
Authorized Official - Last Name:WALL-FEYEN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:608-348-3156
Mailing Address - Street 1:470 S WATER ST
Mailing Address - Street 2:
Mailing Address - City:PLATTEVILLE
Mailing Address - State:WI
Mailing Address - Zip Code:53818-3607
Mailing Address - Country:US
Mailing Address - Phone:608-348-3156
Mailing Address - Fax:608-348-3176
Practice Address - Street 1:470 S WATER ST
Practice Address - Street 2:
Practice Address - City:PLATTEVILLE
Practice Address - State:WI
Practice Address - Zip Code:53818-3607
Practice Address - Country:US
Practice Address - Phone:608-348-3156
Practice Address - Fax:608-348-3176
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-31
Last Update Date:2010-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI38986000Medicaid
WI561661OtherDEAN HEALTH PLAN
WI38986000Medicaid
WI=========019OtherBCBS OF WI