Provider Demographics
NPI:1891933388
Name:VINCENT E SEILER DBA MUKWONAGO FAMILY CHIROPRACTIC
Entity Type:Organization
Organization Name:VINCENT E SEILER DBA MUKWONAGO FAMILY CHIROPRACTIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:VINCENT
Authorized Official - Middle Name:
Authorized Official - Last Name:SEILER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:262-363-7545
Mailing Address - Street 1:1231 S ROCHESTER ST
Mailing Address - Street 2:STE 230
Mailing Address - City:MUKWONAGO
Mailing Address - State:WI
Mailing Address - Zip Code:53149-9031
Mailing Address - Country:US
Mailing Address - Phone:262-363-7545
Mailing Address - Fax:262-363-7543
Practice Address - Street 1:1231 S ROCHESTER ST
Practice Address - Street 2:STE 230
Practice Address - City:MUKWONAGO
Practice Address - State:WI
Practice Address - Zip Code:53149-9031
Practice Address - Country:US
Practice Address - Phone:262-363-7545
Practice Address - Fax:262-363-7543
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-01-22
Last Update Date:2017-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI3863-012111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WIU68004Medicare UPIN