Provider Demographics
NPI:1023164332
Name:NEWPORTE COURTE FAMILY CHIROPRACTIC, LLC
Entity type:Organization
Organization Name:NEWPORTE COURTE FAMILY CHIROPRACTIC, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER, VICE PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MARIAH
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:GOECKE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:262-240-1600
Mailing Address - Street 1:10532 N PORT WASHINGTON RD
Mailing Address - Street 2:
Mailing Address - City:MEQUON
Mailing Address - State:WI
Mailing Address - Zip Code:53092-5563
Mailing Address - Country:US
Mailing Address - Phone:262-240-1600
Mailing Address - Fax:262-240-1602
Practice Address - Street 1:10532 N PORT WASHINGTON RD
Practice Address - Street 2:
Practice Address - City:MEQUON
Practice Address - State:WI
Practice Address - Zip Code:53092-5563
Practice Address - Country:US
Practice Address - Phone:262-240-1600
Practice Address - Fax:262-240-1602
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-27
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI4127-012111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty