Provider Demographics
NPI:1770758179
Name:HABIGHORST CHIROPRACTIC SC
Entity type:Organization
Organization Name:HABIGHORST CHIROPRACTIC SC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:G
Authorized Official - Last Name:HABIGHORST
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:920-882-7292
Mailing Address - Street 1:1981 MIDWAY RD
Mailing Address - Street 2:SUITE A
Mailing Address - City:MENASHA
Mailing Address - State:WI
Mailing Address - Zip Code:54952-7001
Mailing Address - Country:US
Mailing Address - Phone:920-882-7292
Mailing Address - Fax:
Practice Address - Street 1:1981 MIDWAY RD
Practice Address - Street 2:SUITE A
Practice Address - City:MENASHA
Practice Address - State:WI
Practice Address - Zip Code:54952-7001
Practice Address - Country:US
Practice Address - Phone:920-882-7292
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-25
Last Update Date:2008-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI38824900Medicaid
WI38824900Medicaid
WI000035639Medicare PIN