Provider Demographics
NPI:1184950396
Name:BAYSHORE CHIROPRACTIC, S.C.
Entity type:Organization
Organization Name:BAYSHORE CHIROPRACTIC, S.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:NATHAN
Authorized Official - Middle Name:
Authorized Official - Last Name:JACKSON
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:920-834-7034
Mailing Address - Street 1:1008B PECOR ST
Mailing Address - Street 2:P.O. BOX 131
Mailing Address - City:OCONTO
Mailing Address - State:WI
Mailing Address - Zip Code:54153-1552
Mailing Address - Country:US
Mailing Address - Phone:920-834-7034
Mailing Address - Fax:920-834-2844
Practice Address - Street 1:1008B PECOR ST
Practice Address - Street 2:
Practice Address - City:OCONTO
Practice Address - State:WI
Practice Address - Zip Code:54153-1552
Practice Address - Country:US
Practice Address - Phone:920-834-7034
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-10-22
Last Update Date:2010-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty