Provider Demographics
NPI:1801186606
Name:NEMITZ FAMILY CHIROPRACTIC LLC
Entity Type:Organization
Organization Name:NEMITZ FAMILY CHIROPRACTIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:STEFFANIE
Authorized Official - Middle Name:R
Authorized Official - Last Name:NEMITZ
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:608-988-6152
Mailing Address - Street 1:188 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:BENTON
Mailing Address - State:WI
Mailing Address - Zip Code:53803-9711
Mailing Address - Country:US
Mailing Address - Phone:608-759-6152
Mailing Address - Fax:608-759-6153
Practice Address - Street 1:188 E MAIN ST
Practice Address - Street 2:
Practice Address - City:BENTON
Practice Address - State:WI
Practice Address - Zip Code:53803
Practice Address - Country:US
Practice Address - Phone:608-759-6152
Practice Address - Fax:608-759-6153
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-04-13
Last Update Date:2018-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI4619-012111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WIWI1952OtherMEDICARE PTAN