Provider Demographics
NPI:1750576542
Name:DORN CHIROPRACTIC, LLC
Entity type:Organization
Organization Name:DORN CHIROPRACTIC, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER OF DORN CHIROPRACTIC, LLC.
Authorized Official - Prefix:DR
Authorized Official - First Name:BRADY
Authorized Official - Middle Name:
Authorized Official - Last Name:DORN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:262-560-9600
Mailing Address - Street 1:888 THACKERAY TRL
Mailing Address - Street 2:SUITE 210
Mailing Address - City:OCONOMOWOC
Mailing Address - State:WI
Mailing Address - Zip Code:53066-4342
Mailing Address - Country:US
Mailing Address - Phone:262-560-9600
Mailing Address - Fax:262-560-9599
Practice Address - Street 1:888 THACKERAY TRL
Practice Address - Street 2:SUITE 210
Practice Address - City:OCONOMOWOC
Practice Address - State:WI
Practice Address - Zip Code:53066-4342
Practice Address - Country:US
Practice Address - Phone:262-560-9600
Practice Address - Fax:262-560-9599
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-13
Last Update Date:2012-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI3622-012111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty