Provider Demographics
NPI:1255701496
Name:CHIROPRACTIC HEALTH SERVICE SC
Entity type:Organization
Organization Name:CHIROPRACTIC HEALTH SERVICE SC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:S
Authorized Official - Last Name:WAKEFIELD
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:715-762-2950
Mailing Address - Street 1:500 BIRCH ST
Mailing Address - Street 2:PO BOX 189
Mailing Address - City:PARK FALLS
Mailing Address - State:WI
Mailing Address - Zip Code:54552-1415
Mailing Address - Country:US
Mailing Address - Phone:715-762-2950
Mailing Address - Fax:
Practice Address - Street 1:500 BIRCH ST
Practice Address - Street 2:
Practice Address - City:PARK FALLS
Practice Address - State:WI
Practice Address - Zip Code:54552-1415
Practice Address - Country:US
Practice Address - Phone:715-762-2950
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-09-30
Last Update Date:2016-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI3939-24225100000X
WI2521-012111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty