Provider Demographics
NPI:1861834020
Name:BADGERLAND CHIROPRACTIC LLC
Entity Type:Organization
Organization Name:BADGERLAND CHIROPRACTIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RYAN
Authorized Official - Middle Name:FRANCIS
Authorized Official - Last Name:DUNPHY
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:608-445-9911
Mailing Address - Street 1:2025 OLD HUMES RD
Mailing Address - Street 2:
Mailing Address - City:JANESVILLE
Mailing Address - State:WI
Mailing Address - Zip Code:53545-0275
Mailing Address - Country:US
Mailing Address - Phone:608-754-0148
Mailing Address - Fax:608-754-0217
Practice Address - Street 1:2025 OLD HUMES RD
Practice Address - Street 2:
Practice Address - City:JANESVILLE
Practice Address - State:WI
Practice Address - Zip Code:53545-0275
Practice Address - Country:US
Practice Address - Phone:608-754-0148
Practice Address - Fax:608-754-0217
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-07-29
Last Update Date:2014-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI4907-12111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI1912244765Medicaid
WI1912244765Medicaid