Provider Demographics
NPI:1720269913
Name:DAVID A. SOMMERFELD CHIROPRACTIC, INC.
Entity Type:Organization
Organization Name:DAVID A. SOMMERFELD CHIROPRACTIC, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:A
Authorized Official - Last Name:SOMMERFELD
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:715-235-4222
Mailing Address - Street 1:6 W SAINT PATRICK ST
Mailing Address - Street 2:
Mailing Address - City:RICE LAKE
Mailing Address - State:WI
Mailing Address - Zip Code:54868-2867
Mailing Address - Country:US
Mailing Address - Phone:715-234-4222
Mailing Address - Fax:715-736-0751
Practice Address - Street 1:6 W SAINT PATRICK ST
Practice Address - Street 2:
Practice Address - City:RICE LAKE
Practice Address - State:WI
Practice Address - Zip Code:54868-2867
Practice Address - Country:US
Practice Address - Phone:715-234-4222
Practice Address - Fax:715-736-0751
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-16
Last Update Date:2007-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1595-012111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WIT63377Medicare UPIN