Provider Demographics
NPI:1770611808
Name:CHIROPRACTIC COMPANY - MENOMONEE FALLS LTD
Entity type:Organization
Organization Name:CHIROPRACTIC COMPANY - MENOMONEE FALLS LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:PAUL
Authorized Official - Last Name:CORSI
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:262-253-6779
Mailing Address - Street 1:N96W18743 COUNTY LINE RD
Mailing Address - Street 2:STE G
Mailing Address - City:MENOMONEE FALLS
Mailing Address - State:WI
Mailing Address - Zip Code:53051-7100
Mailing Address - Country:US
Mailing Address - Phone:262-253-6779
Mailing Address - Fax:262-253-6849
Practice Address - Street 1:N96W18743 COUNTY LINE RD
Practice Address - Street 2:STE G
Practice Address - City:MENOMONEE FALLS
Practice Address - State:WI
Practice Address - Zip Code:53051-7100
Practice Address - Country:US
Practice Address - Phone:262-253-6779
Practice Address - Fax:262-253-6849
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CHIROPRACTIC COMPANY S.C.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-03-01
Last Update Date:2017-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
111N00000X
WI3243261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
No111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI38888200Medicaid
U43549Medicare UPIN
000035685Medicare ID - Type Unspecified