Provider Demographics
NPI:1700102894
Name:CHIROPRACTIC CARE CENTER OF HARTLAND
Entity Type:Organization
Organization Name:CHIROPRACTIC CARE CENTER OF HARTLAND
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:L
Authorized Official - Last Name:DRAGGOO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:262-367-4523
Mailing Address - Street 1:PO BOX 510444
Mailing Address - Street 2:
Mailing Address - City:NEW BERLIN
Mailing Address - State:WI
Mailing Address - Zip Code:53151-0444
Mailing Address - Country:US
Mailing Address - Phone:262-785-1811
Mailing Address - Fax:262-785-9887
Practice Address - Street 1:864 ROSE DR
Practice Address - Street 2:
Practice Address - City:HARTLAND
Practice Address - State:WI
Practice Address - Zip Code:53029-8317
Practice Address - Country:US
Practice Address - Phone:262-367-4523
Practice Address - Fax:262-367-4657
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-04-14
Last Update Date:2010-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI3258111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI38921800Medicaid
WI38921800Medicaid