Provider Demographics
NPI:1649348392
Name:BURLINGTON FAMILY CHIROPRACTIC LLC
Entity type:Organization
Organization Name:BURLINGTON FAMILY CHIROPRACTIC LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:C
Authorized Official - Last Name:WHEELOCK
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:262-763-3700
Mailing Address - Street 1:196 W CHESTNUT STREET
Mailing Address - Street 2:
Mailing Address - City:BURLINGTON
Mailing Address - State:WI
Mailing Address - Zip Code:53105
Mailing Address - Country:US
Mailing Address - Phone:262-763-3700
Mailing Address - Fax:262-763-5690
Practice Address - Street 1:196 W CHESTNUT STREET
Practice Address - Street 2:
Practice Address - City:BURLINGTON
Practice Address - State:WI
Practice Address - Zip Code:53105
Practice Address - Country:US
Practice Address - Phone:262-763-3700
Practice Address - Fax:262-763-5690
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-01
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI38992900Medicaid
WI38992900Medicaid
WI38992900Medicaid