Provider Demographics
NPI:1013117811
Name:PACKERLAND CHIROPRACTIC OF DOOR COUNTY INC
Entity type:Organization
Organization Name:PACKERLAND CHIROPRACTIC OF DOOR COUNTY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:ANDREW
Authorized Official - Last Name:NELSON
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:920-746-8252
Mailing Address - Street 1:2615 PACKERLAND DR
Mailing Address - Street 2:STE G
Mailing Address - City:GREEN BAY
Mailing Address - State:WI
Mailing Address - Zip Code:54313-5780
Mailing Address - Country:US
Mailing Address - Phone:920-496-8808
Mailing Address - Fax:920-496-8808
Practice Address - Street 1:430 JEFFERSON ST
Practice Address - Street 2:
Practice Address - City:STURGEON BAY
Practice Address - State:WI
Practice Address - Zip Code:54235-2112
Practice Address - Country:US
Practice Address - Phone:920-746-8252
Practice Address - Fax:920-746-8252
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-19
Last Update Date:2010-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WIU-70394Medicare UPIN