Provider Demographics
NPI:1669536827
Name:CUBA CITY CHIROPRACTIC OFFICE LLC
Entity type:Organization
Organization Name:CUBA CITY CHIROPRACTIC OFFICE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:CHARLES
Authorized Official - Last Name:MISKY
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:608-744-2725
Mailing Address - Street 1:218 E WEBSTER ST
Mailing Address - Street 2:
Mailing Address - City:CUBA CITY
Mailing Address - State:WI
Mailing Address - Zip Code:53807
Mailing Address - Country:US
Mailing Address - Phone:608-744-2725
Mailing Address - Fax:608-744-2725
Practice Address - Street 1:218 E WEBSTER ST
Practice Address - Street 2:
Practice Address - City:CUBA CITY
Practice Address - State:WI
Practice Address - Zip Code:53807
Practice Address - Country:US
Practice Address - Phone:608-744-2725
Practice Address - Fax:608-744-2725
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-21
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
391786792005OtherBLUE CROSS BLUE SHIELD
WI38852000Medicaid
WI38852000Medicaid