Provider Demographics
NPI:1265148142
Name:MCGINNIS CHIROPRACTIC HEALTH CLINIC
Entity type:Organization
Organization Name:MCGINNIS CHIROPRACTIC HEALTH CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SAMUEL
Authorized Official - Middle Name:JOHN EDWARD
Authorized Official - Last Name:MCGINNIS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:920-850-5448
Mailing Address - Street 1:11 N 6TH AVE
Mailing Address - Street 2:
Mailing Address - City:WINNECONNE
Mailing Address - State:WI
Mailing Address - Zip Code:54986-9705
Mailing Address - Country:US
Mailing Address - Phone:920-850-5448
Mailing Address - Fax:920-582-4004
Practice Address - Street 1:11 N 6TH AVE
Practice Address - Street 2:
Practice Address - City:WINNECONNE
Practice Address - State:WI
Practice Address - Zip Code:54986-9705
Practice Address - Country:US
Practice Address - Phone:920-850-5448
Practice Address - Fax:920-582-4004
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-01-25
Last Update Date:2023-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NX0100XChiropractic ProvidersChiropractorOccupational HealthGroup - Multi-Specialty