Provider Demographics
NPI:1205961331
Name:PARK PLACE CHIROPRACTIC, LLC
Entity type:Organization
Organization Name:PARK PLACE CHIROPRACTIC, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:ANDREW
Authorized Official - Middle Name:
Authorized Official - Last Name:PAULL
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:608-754-7463
Mailing Address - Street 1:1831 W COURT ST
Mailing Address - Street 2:
Mailing Address - City:JANESVILLE
Mailing Address - State:WI
Mailing Address - Zip Code:53548-3406
Mailing Address - Country:US
Mailing Address - Phone:608-754-7463
Mailing Address - Fax:608-754-1437
Practice Address - Street 1:1831 W COURT ST
Practice Address - Street 2:
Practice Address - City:JANESVILLE
Practice Address - State:WI
Practice Address - Zip Code:53548-3406
Practice Address - Country:US
Practice Address - Phone:608-754-7463
Practice Address - Fax:608-754-1437
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-22
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI4035-012111N00000X, 111NS0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
Not Answered111NS0005XChiropractic ProvidersChiropractorSports PhysicianGroup - Multi-Specialty