Provider Demographics
NPI:1740351345
Name:AMERY CHIROPRACTIC LLC
Entity type:Organization
Organization Name:AMERY CHIROPRACTIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:STEPHANIE
Authorized Official - Middle Name:J
Authorized Official - Last Name:HANSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:715-268-9146
Mailing Address - Street 1:408 KELLER AVE S
Mailing Address - Street 2:
Mailing Address - City:AMERY
Mailing Address - State:WI
Mailing Address - Zip Code:54001-1220
Mailing Address - Country:US
Mailing Address - Phone:715-268-9146
Mailing Address - Fax:715-268-6907
Practice Address - Street 1:408 KELLER AVE S
Practice Address - Street 2:
Practice Address - City:AMERY
Practice Address - State:WI
Practice Address - Zip Code:54001-1220
Practice Address - Country:US
Practice Address - Phone:715-268-9146
Practice Address - Fax:715-268-6907
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-13
Last Update Date:2017-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WICD7725OtherRR MEDICARE
MN60669GOOtherBCBS OF MN
WI391839143016OtherBCBS OF WI
WI000035800Medicare ID - Type Unspecified