Provider Demographics
NPI:1508920778
Name:CHIROPRACTIC COMPANY - MILWAUKEE NORTH LTD
Entity type:Organization
Organization Name:CHIROPRACTIC COMPANY - MILWAUKEE NORTH LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:P
Authorized Official - Last Name:CORSI
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:414-359-0300
Mailing Address - Street 1:10855 WEST PARK PLACE
Mailing Address - Street 2:SUITE 9
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53224
Mailing Address - Country:US
Mailing Address - Phone:414-359-0300
Mailing Address - Fax:414-359-0303
Practice Address - Street 1:10855 WEST PARK PLACE
Practice Address - Street 2:SUITE 9
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53224
Practice Address - Country:US
Practice Address - Phone:414-359-0300
Practice Address - Fax:414-359-0303
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CHIROPRACTIC COMPANY S.C.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-12-21
Last Update Date:2017-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI0001845111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI38788300Medicaid
WI38788300Medicaid
WI000075708Medicare PIN
WIT62392Medicare UPIN