Provider Demographics
NPI:1871681924
Name:ASPEN CREEK CHIROPRACTIC LLC
Entity Type:Organization
Organization Name:ASPEN CREEK CHIROPRACTIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTINE
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:STORLEY
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:608-837-2828
Mailing Address - Street 1:1268 WEST MAIN STREET
Mailing Address - Street 2:SUITE 2
Mailing Address - City:SUN PRAIRIE
Mailing Address - State:WI
Mailing Address - Zip Code:53590-1930
Mailing Address - Country:US
Mailing Address - Phone:608-837-2828
Mailing Address - Fax:608-837-0105
Practice Address - Street 1:1268 WEST MAIN STREET
Practice Address - Street 2:SUITE 2
Practice Address - City:SUN PRAIRIE
Practice Address - State:WI
Practice Address - Zip Code:53590-1930
Practice Address - Country:US
Practice Address - Phone:608-837-2828
Practice Address - Fax:608-837-0105
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-11
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI3778012111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI39003200Medicaid
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