Provider Demographics
NPI:1780774760
Name:BAY CARE COMPLEMENTARY HEALTH
Entity type:Organization
Organization Name:BAY CARE COMPLEMENTARY HEALTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:TREASURER
Authorized Official - Prefix:DR
Authorized Official - First Name:WADE
Authorized Official - Middle Name:D
Authorized Official - Last Name:SKOGMAN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:920-288-8383
Mailing Address - Street 1:2845 GREENBRIER RD
Mailing Address - Street 2:P O BOX 8900 SUITE 340
Mailing Address - City:GREEN BAY
Mailing Address - State:WI
Mailing Address - Zip Code:54311-6519
Mailing Address - Country:US
Mailing Address - Phone:920-288-8383
Mailing Address - Fax:920-288-8385
Practice Address - Street 1:2845 GREENBRIER RD
Practice Address - Street 2:
Practice Address - City:GREEN BAY
Practice Address - State:WI
Practice Address - Zip Code:54311-6519
Practice Address - Country:US
Practice Address - Phone:920-288-8383
Practice Address - Fax:920-288-8385
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-13
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2576111N00000X
WI2216111N00000X
WI3140111N00000X
WI2312111N00000X
WI1783111NN0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
Not Answered111NN0400XChiropractic ProvidersChiropractorNeurologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI38995400Medicaid