Provider Demographics
NPI:1356343156
Name:MEQUON CHIROPRACTIC OFFICE SC
Entity type:Organization
Organization Name:MEQUON CHIROPRACTIC OFFICE SC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:SHERRI
Authorized Official - Middle Name:
Authorized Official - Last Name:AUGUSTINE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:262-241-3434
Mailing Address - Street 1:10521 N PORT WASHINGTON RD
Mailing Address - Street 2:STE 130
Mailing Address - City:MEQUON
Mailing Address - State:WI
Mailing Address - Zip Code:53092-5584
Mailing Address - Country:US
Mailing Address - Phone:262-241-3434
Mailing Address - Fax:262-241-3903
Practice Address - Street 1:10521 N PORT WASHINGTON RD
Practice Address - Street 2:STE 130
Practice Address - City:MEQUON
Practice Address - State:WI
Practice Address - Zip Code:53092-5584
Practice Address - Country:US
Practice Address - Phone:262-241-3434
Practice Address - Fax:262-241-3903
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-11
Last Update Date:2013-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI000075770Medicare UPIN