Provider Demographics
NPI:1841595030
Name:CHIROPRACTIC COMPANY - SHOREWOOD
Entity Type:Organization
Organization Name:CHIROPRACTIC COMPANY - SHOREWOOD
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:BETTY LOU
Authorized Official - Middle Name:
Authorized Official - Last Name:DELICH
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:414-962-0700
Mailing Address - Street 1:3510 N OAKLAND AVE
Mailing Address - Street 2:STE. 201
Mailing Address - City:SHOREWOOD
Mailing Address - State:WI
Mailing Address - Zip Code:53211-2746
Mailing Address - Country:US
Mailing Address - Phone:414-962-0700
Mailing Address - Fax:414-962-0442
Practice Address - Street 1:3510 N OAKLAND AVE
Practice Address - Street 2:STE. 201
Practice Address - City:SHOREWOOD
Practice Address - State:WI
Practice Address - Zip Code:53211-2746
Practice Address - Country:US
Practice Address - Phone:414-962-0700
Practice Address - Fax:414-962-0442
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:2011-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI3710111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty