Provider Demographics
NPI:1942460357
Name:MT. PLEASANT CHIROPRACTIC & REHAB LLC
Entity Type:Organization
Organization Name:MT. PLEASANT CHIROPRACTIC & REHAB LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING SPECIALIST
Authorized Official - Prefix:MS
Authorized Official - First Name:LISA
Authorized Official - Middle Name:J
Authorized Official - Last Name:BARNETT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:920-334-4561
Mailing Address - Street 1:5332 SPRING ST
Mailing Address - Street 2:
Mailing Address - City:MOUNT PLEASANT
Mailing Address - State:WI
Mailing Address - Zip Code:53406-2910
Mailing Address - Country:US
Mailing Address - Phone:262-633-6325
Mailing Address - Fax:262-633-6326
Practice Address - Street 1:5332 SPRING ST
Practice Address - Street 2:
Practice Address - City:MOUNT PLEASANT
Practice Address - State:WI
Practice Address - Zip Code:53406-2910
Practice Address - Country:US
Practice Address - Phone:262-633-6325
Practice Address - Fax:262-633-6326
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-10
Last Update Date:2019-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI35658Medicare PIN