Provider Demographics
NPI:1922283142
Name:DAVID DOW CHIROPRACTIC SC
Entity Type:Organization
Organization Name:DAVID DOW CHIROPRACTIC SC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:DOW
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:608-233-3588
Mailing Address - Street 1:3310 UNIVERSITY AVE
Mailing Address - Street 2:SUITE 204
Mailing Address - City:MADISON
Mailing Address - State:WI
Mailing Address - Zip Code:53705-2135
Mailing Address - Country:US
Mailing Address - Phone:608-233-3588
Mailing Address - Fax:608-233-5724
Practice Address - Street 1:3310 UNIVERSITY AVE
Practice Address - Street 2:SUITE 204
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53705-2135
Practice Address - Country:US
Practice Address - Phone:608-233-3588
Practice Address - Fax:608-233-5724
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-07
Last Update Date:2008-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI3030-012111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI38894200Medicaid
WI38894200Medicaid
U61714Medicare UPIN