Provider Demographics
NPI:1992827554
Name:CHIROPRACTIC COMPANY - CEDARBURG LTD
Entity Type:Organization
Organization Name:CHIROPRACTIC COMPANY - CEDARBURG LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:P
Authorized Official - Last Name:CORSI
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:414-354-5377
Mailing Address - Street 1:N144 W6220 PIONEER RD
Mailing Address - Street 2:
Mailing Address - City:CEDARBURG
Mailing Address - State:WI
Mailing Address - Zip Code:53012-2723
Mailing Address - Country:US
Mailing Address - Phone:262-377-3240
Mailing Address - Fax:262-377-9102
Practice Address - Street 1:N144 W6220 PIONEER RD
Practice Address - Street 2:
Practice Address - City:CEDARBURG
Practice Address - State:WI
Practice Address - Zip Code:53012-2723
Practice Address - Country:US
Practice Address - Phone:262-377-3240
Practice Address - Fax:262-377-9102
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-04
Last Update Date:2022-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1417111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI38754600Medicaid
WI38754600Medicaid
T62210Medicare UPIN