Provider Demographics
NPI:1801135371
Name:HABECK CHIROPRACTIC CENTER, LLC
Entity type:Organization
Organization Name:HABECK CHIROPRACTIC CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ADAM
Authorized Official - Middle Name:ROBERT
Authorized Official - Last Name:HABECK
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:715-276-3401
Mailing Address - Street 1:PO BOX 328
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:WI
Mailing Address - Zip Code:54138-0328
Mailing Address - Country:US
Mailing Address - Phone:715-276-3401
Mailing Address - Fax:715-276-1533
Practice Address - Street 1:15267 STATE HWY. 32
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:WI
Practice Address - Zip Code:54138
Practice Address - Country:US
Practice Address - Phone:715-276-3401
Practice Address - Fax:715-276-1533
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-02-04
Last Update Date:2017-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI4633-12111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty