Provider Demographics
NPI:1154699759
Name:RACINE FAMILY CARE CHIROPRACTIC, LLC
Entity type:Organization
Organization Name:RACINE FAMILY CARE CHIROPRACTIC, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:SHARON
Authorized Official - Middle Name:
Authorized Official - Last Name:HILL
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:262-633-4016
Mailing Address - Street 1:2710 WRIGHT AVE
Mailing Address - Street 2:
Mailing Address - City:RACINE
Mailing Address - State:WI
Mailing Address - Zip Code:53405-5007
Mailing Address - Country:US
Mailing Address - Phone:262-633-4016
Mailing Address - Fax:262-633-0655
Practice Address - Street 1:2710 WRIGHT AVE
Practice Address - Street 2:
Practice Address - City:RACINE
Practice Address - State:WI
Practice Address - Zip Code:53405-5007
Practice Address - Country:US
Practice Address - Phone:262-633-4016
Practice Address - Fax:262-633-0655
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-12-09
Last Update Date:2012-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2497111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI000070302Medicare UPIN