Provider Demographics
NPI:1720280522
Name:JOSEPH CHIROPRACTIC SC
Entity Type:Organization
Organization Name:JOSEPH CHIROPRACTIC SC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:EDWARD
Authorized Official - Last Name:JOSEPH
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:608-254-4244
Mailing Address - Street 1:1000 ST. HWY. 13
Mailing Address - Street 2:PO BOX 49
Mailing Address - City:WISCONSIN DELLS
Mailing Address - State:WI
Mailing Address - Zip Code:53965-0049
Mailing Address - Country:US
Mailing Address - Phone:608-254-4244
Mailing Address - Fax:608-253-5714
Practice Address - Street 1:1000 ST HWY 13
Practice Address - Street 2:
Practice Address - City:WISCONSIN DELLS
Practice Address - State:WI
Practice Address - Zip Code:53965-0049
Practice Address - Country:US
Practice Address - Phone:608-254-4244
Practice Address - Fax:608-253-5714
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-04
Last Update Date:2012-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI3556012111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WIP00154710OtherMEDICARE RR
WI558386OtherDEAN CARE
WIP00154710OtherMEDICARE RR
WI558386OtherDEAN CARE
WIU68044Medicare UPIN