Provider Demographics
NPI:1972051332
Name:YENTZ FAMILY CHIROPRACTIC LLC
Entity Type:Organization
Organization Name:YENTZ FAMILY CHIROPRACTIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:KARL
Authorized Official - Middle Name:
Authorized Official - Last Name:YENTZ
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:608-393-5574
Mailing Address - Street 1:N112W16076 MEQUON RD STE A2
Mailing Address - Street 2:
Mailing Address - City:GERMANTOWN
Mailing Address - State:WI
Mailing Address - Zip Code:53022-3333
Mailing Address - Country:US
Mailing Address - Phone:608-393-5574
Mailing Address - Fax:
Practice Address - Street 1:N112W16076 MEQUON RD STE A2
Practice Address - Street 2:
Practice Address - City:GERMANTOWN
Practice Address - State:WI
Practice Address - Zip Code:53022-3333
Practice Address - Country:US
Practice Address - Phone:608-393-5574
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-09-14
Last Update Date:2016-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI5122-12111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty