Provider Demographics
NPI:1245455153
Name:CHIROPRACTIC COMPANY - WAUKESHA LTD
Entity type:Organization
Organization Name:CHIROPRACTIC COMPANY - WAUKESHA LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:PAUL
Authorized Official - Last Name:CORSI
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:144-354-5377
Mailing Address - Street 1:161 W SUNSET DR
Mailing Address - Street 2:
Mailing Address - City:WAUKESHA
Mailing Address - State:WI
Mailing Address - Zip Code:53189-7674
Mailing Address - Country:US
Mailing Address - Phone:262-549-0606
Mailing Address - Fax:262-549-9121
Practice Address - Street 1:161 W SUNSET DR
Practice Address - Street 2:
Practice Address - City:WAUKESHA
Practice Address - State:WI
Practice Address - Zip Code:53189-7674
Practice Address - Country:US
Practice Address - Phone:262-549-0606
Practice Address - Fax:262-549-9121
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CHIROPRACTIC COMPANY S.C.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-04-16
Last Update Date:2019-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1929111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI38785900Medicaid
WI75-733Medicare ID - Type Unspecified
WI38785900Medicaid