Provider Demographics
NPI:1962661264
Name:SCHULTZ CHIROPRACTIC LLC
Entity Type:Organization
Organization Name:SCHULTZ CHIROPRACTIC LLC
Other - Org Name:HALLIE CHIROPRACTIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:E
Authorized Official - Last Name:SCHULTZ
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:715-831-6052
Mailing Address - Street 1:1650 HALLIE RD
Mailing Address - Street 2:
Mailing Address - City:CHIPPEWA FALLS
Mailing Address - State:WI
Mailing Address - Zip Code:54729-6521
Mailing Address - Country:US
Mailing Address - Phone:715-831-6052
Mailing Address - Fax:715-831-6141
Practice Address - Street 1:1650 HALLIE RD
Practice Address - Street 2:
Practice Address - City:CHIPPEWA FALLS
Practice Address - State:WI
Practice Address - Zip Code:54729-6521
Practice Address - Country:US
Practice Address - Phone:715-831-6052
Practice Address - Fax:715-831-6141
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-03
Last Update Date:2017-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI3766-012111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI33-3899900Medicaid
WI=========011OtherANTHEM BCBS