Provider Demographics
NPI:1669779815
Name:Z CHIROPRACTIC, LLC
Entity type:Organization
Organization Name:Z CHIROPRACTIC, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:ZITZKE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:414-744-5010
Mailing Address - Street 1:2331 S KINNICKINNIC AVE
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53207-1625
Mailing Address - Country:US
Mailing Address - Phone:414-744-5010
Mailing Address - Fax:414-744-5141
Practice Address - Street 1:2331 S KINNICKINNIC AVE
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53207-1625
Practice Address - Country:US
Practice Address - Phone:414-744-5010
Practice Address - Fax:414-744-5141
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-02-24
Last Update Date:2011-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI4119-012111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI38967200Medicaid
V05970Medicare UPIN
WI38967200Medicaid