Provider Demographics
NPI:1457343246
Name:LUEDTKE-STORM-MACKEY CHIROPRACTIC CLINIC SC
Entity Type:Organization
Organization Name:LUEDTKE-STORM-MACKEY CHIROPRACTIC CLINIC SC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:NATHAN
Authorized Official - Middle Name:L
Authorized Official - Last Name:CONSIDINE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:608-963-4722
Mailing Address - Street 1:105 CLARMAR DRIVE
Mailing Address - Street 2:
Mailing Address - City:SUN PRAIRIE
Mailing Address - State:WI
Mailing Address - Zip Code:53590
Mailing Address - Country:US
Mailing Address - Phone:608-316-6972
Mailing Address - Fax:
Practice Address - Street 1:105 CLARMAR DRIVE
Practice Address - Street 2:
Practice Address - City:SUN PRAIRIE
Practice Address - State:WI
Practice Address - Zip Code:53590
Practice Address - Country:US
Practice Address - Phone:608-316-6972
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-17
Last Update Date:2023-02-01
Deactivation Date:2022-10-13
Deactivation Code:
Reactivation Date:2022-11-07
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI000035220Medicare PIN
WI000070207Medicare PIN