Provider Demographics
NPI:1891980231
Name:JOHNS CHIROPRACTIC CLINIC, SC
Entity Type:Organization
Organization Name:JOHNS CHIROPRACTIC CLINIC, SC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:CARMEN
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:JOHNS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:414-321-2273
Mailing Address - Street 1:7701 W BARNARD AVE
Mailing Address - Street 2:
Mailing Address - City:GREENFIELD
Mailing Address - State:WI
Mailing Address - Zip Code:53220-4223
Mailing Address - Country:US
Mailing Address - Phone:414-321-2273
Mailing Address - Fax:
Practice Address - Street 1:7701 W BARNARD AVE
Practice Address - Street 2:
Practice Address - City:GREENFIELD
Practice Address - State:WI
Practice Address - Zip Code:53220-4223
Practice Address - Country:US
Practice Address - Phone:414-321-2273
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-10
Last Update Date:2007-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2547-012305R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305R00000XManaged Care OrganizationsPreferred Provider Organization
Provider Identifiers
StateIdentifier IDID TypeIssuer
WIU11455Medicare UPIN