Provider Demographics
NPI:1255388633
Name:PAULSRUD CHIROPRACTIC LLC
Entity type:Organization
Organization Name:PAULSRUD CHIROPRACTIC LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:TERESA
Authorized Official - Middle Name:M
Authorized Official - Last Name:PAULSRUD
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:715-552-3232
Mailing Address - Street 1:2627 N CLAIREMONT AVE
Mailing Address - Street 2:
Mailing Address - City:EAU CLAIRE
Mailing Address - State:WI
Mailing Address - Zip Code:54703-2405
Mailing Address - Country:US
Mailing Address - Phone:715-552-3232
Mailing Address - Fax:715-552-3233
Practice Address - Street 1:2627 N CLAIREMONT AVE
Practice Address - Street 2:
Practice Address - City:EAU CLAIRE
Practice Address - State:WI
Practice Address - Zip Code:54703-2405
Practice Address - Country:US
Practice Address - Phone:715-552-3232
Practice Address - Fax:715-552-3233
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-30
Last Update Date:2010-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI000020350Medicare PIN