Provider Demographics
NPI:1740470996
Name:SPENNETTA FAMILY CARE CHIROPRACTIC, S.C.
Entity type:Organization
Organization Name:SPENNETTA FAMILY CARE CHIROPRACTIC, S.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:A
Authorized Official - Last Name:SPENNETTA
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:608-273-2225
Mailing Address - Street 1:6810 WATTS RD
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:WI
Mailing Address - Zip Code:53719-1320
Mailing Address - Country:US
Mailing Address - Phone:608-273-2225
Mailing Address - Fax:
Practice Address - Street 1:6810 WATTS RD
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53719-1320
Practice Address - Country:US
Practice Address - Phone:608-273-2225
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-25
Last Update Date:2014-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2813111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI38862500Medicaid
WI38862500Medicaid
WI000075909Medicare PIN