Provider Demographics
NPI:1457545998
Name:MEISTER CHIROPRACTIC SC
Entity Type:Organization
Organization Name:MEISTER CHIROPRACTIC SC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRES.
Authorized Official - Prefix:DR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:ALLEN
Authorized Official - Last Name:MEISTER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:608-837-9114
Mailing Address - Street 1:804 LIBERTY BLVD
Mailing Address - Street 2:SUITE 208
Mailing Address - City:SUN PRAIRIE
Mailing Address - State:WI
Mailing Address - Zip Code:53590-4500
Mailing Address - Country:US
Mailing Address - Phone:608-837-9114
Mailing Address - Fax:608-837-9521
Practice Address - Street 1:804 LIBERTY BLVD
Practice Address - Street 2:SUITE 208
Practice Address - City:SUN PRAIRIE
Practice Address - State:WI
Practice Address - Zip Code:53590-4500
Practice Address - Country:US
Practice Address - Phone:608-837-9114
Practice Address - Fax:608-837-9521
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-28
Last Update Date:2015-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI000115380Medicare PIN