Provider Demographics
NPI:1922207612
Name:EARLY CLINIC OF CHIROPRACTIC LLC
Entity Type:Organization
Organization Name:EARLY CLINIC OF CHIROPRACTIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:ANDREW
Authorized Official - Last Name:EARLY
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:920-322-9594
Mailing Address - Street 1:1211 RICKMEYER DR
Mailing Address - Street 2:
Mailing Address - City:FOND DU LAC
Mailing Address - State:WI
Mailing Address - Zip Code:54937-2213
Mailing Address - Country:US
Mailing Address - Phone:920-322-9594
Mailing Address - Fax:920-322-9676
Practice Address - Street 1:1211 RICKMEYER DR
Practice Address - Street 2:
Practice Address - City:FOND DU LAC
Practice Address - State:WI
Practice Address - Zip Code:54937-2213
Practice Address - Country:US
Practice Address - Phone:920-322-9594
Practice Address - Fax:920-322-9676
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-13
Last Update Date:2008-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI38950600Medicaid
WI38950600Medicaid