Provider Demographics
NPI:1972659498
Name:OSHKOSH CHIROPRACTIC CENTER, S.C.
Entity Type:Organization
Organization Name:OSHKOSH CHIROPRACTIC CENTER, S.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:F
Authorized Official - Last Name:GEORGE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:920-231-7010
Mailing Address - Street 1:313 WASHINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:OSHKOSH
Mailing Address - State:WI
Mailing Address - Zip Code:54901-5041
Mailing Address - Country:US
Mailing Address - Phone:920-231-7010
Mailing Address - Fax:920-231-1292
Practice Address - Street 1:313 WASHINGTON AVE
Practice Address - Street 2:
Practice Address - City:OSHKOSH
Practice Address - State:WI
Practice Address - Zip Code:54901-5041
Practice Address - Country:US
Practice Address - Phone:920-231-7010
Practice Address - Fax:920-231-1292
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-26
Last Update Date:2010-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2846111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI38864200Medicaid
WI38864200Medicaid
WI000070368Medicare ID - Type Unspecified