Provider Demographics
NPI:1205131406
Name:CHIROPRACTIC COMPANY - BROOKFIELD LTD
Entity type:Organization
Organization Name:CHIROPRACTIC COMPANY - BROOKFIELD LTD
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CLINIC DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:TAYLOR
Authorized Official - Middle Name:JEROME
Authorized Official - Last Name:POEHLS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:262-374-2885
Mailing Address - Street 1:1905 N CALHOUN RD STE 115
Mailing Address - Street 2:
Mailing Address - City:BROOKFIELD
Mailing Address - State:WI
Mailing Address - Zip Code:53005-5036
Mailing Address - Country:US
Mailing Address - Phone:262-782-2273
Mailing Address - Fax:
Practice Address - Street 1:1905 N CALHOUN RD STE 115
Practice Address - Street 2:
Practice Address - City:BROOKFIELD
Practice Address - State:WI
Practice Address - Zip Code:53005
Practice Address - Country:US
Practice Address - Phone:262-782-2273
Practice Address - Fax:262-257-9966
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CHIROPRACTIC COMPANY, S.C.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2011-01-19
Last Update Date:2024-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI3397111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty