Provider Demographics
NPI:1891909503
Name:BAERTLEIN CHIROPRACTIC LLC
Entity Type:Organization
Organization Name:BAERTLEIN CHIROPRACTIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KRISTA
Authorized Official - Middle Name:MARY
Authorized Official - Last Name:BAERTLEIN-LEBERFING
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:262-925-8600
Mailing Address - Street 1:5027 GREEN BAY ROAD
Mailing Address - Street 2:SUITE 118
Mailing Address - City:RACINE
Mailing Address - State:WI
Mailing Address - Zip Code:53144-1771
Mailing Address - Country:US
Mailing Address - Phone:262-925-8600
Mailing Address - Fax:262-925-8599
Practice Address - Street 1:5027 GREEN BAY ROAD
Practice Address - Street 2:SUITE 118
Practice Address - City:RACINE
Practice Address - State:WI
Practice Address - Zip Code:53144-1771
Practice Address - Country:US
Practice Address - Phone:262-925-8600
Practice Address - Fax:262-925-8599
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-10
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI3743-012111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty