Provider Demographics
NPI:1891867677
Name:CASCO FAMILY CHIROPRACTIC CLINIC
Entity Type:Organization
Organization Name:CASCO FAMILY CHIROPRACTIC CLINIC
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:HOLLIS-HEIMAN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:920-388-0499
Mailing Address - Street 1:E3447 SWAMP LN
Mailing Address - Street 2:
Mailing Address - City:KEWAUNEE
Mailing Address - State:WI
Mailing Address - Zip Code:54216-9770
Mailing Address - Country:US
Mailing Address - Phone:920-388-0499
Mailing Address - Fax:920-388-0499
Practice Address - Street 1:E3447 SWAMP LN
Practice Address - Street 2:
Practice Address - City:KEWAUNEE
Practice Address - State:WI
Practice Address - Zip Code:54216-9770
Practice Address - Country:US
Practice Address - Phone:920-388-0499
Practice Address - Fax:920-388-0499
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-15
Last Update Date:2010-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI3816-012111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI000033055Medicare ID - Type UnspecifiedMEDICARE GROUP NUMBER