Provider Demographics
NPI:1891123741
Name:FULL MOTION FAMILY CHIROPRACTIC LLC
Entity Type:Organization
Organization Name:FULL MOTION FAMILY CHIROPRACTIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMIE
Authorized Official - Middle Name:
Authorized Official - Last Name:MABEUS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:262-395-4015
Mailing Address - Street 1:20611 WATERTOWN RD STE B
Mailing Address - Street 2:
Mailing Address - City:WAUKESHA
Mailing Address - State:WI
Mailing Address - Zip Code:53186-1871
Mailing Address - Country:US
Mailing Address - Phone:262-395-4015
Mailing Address - Fax:262-649-3600
Practice Address - Street 1:20611 WATERTOWN RD STE B
Practice Address - Street 2:
Practice Address - City:WAUKESHA
Practice Address - State:WI
Practice Address - Zip Code:53186-1871
Practice Address - Country:US
Practice Address - Phone:262-395-4015
Practice Address - Fax:262-649-3600
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-10-30
Last Update Date:2014-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI4937-12111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WIK100118588Medicare PIN