Provider Demographics
NPI:1811056096
Name:NORTH SHORE CHIROPRACTIC, LLC.
Entity type:Organization
Organization Name:NORTH SHORE CHIROPRACTIC, LLC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:KENDAL
Authorized Official - Middle Name:JOEL
Authorized Official - Last Name:HOARD
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:262-478-0033
Mailing Address - Street 1:1516 W MEQUON RD
Mailing Address - Street 2:SUITE 202
Mailing Address - City:MEQUON
Mailing Address - State:WI
Mailing Address - Zip Code:53092-3264
Mailing Address - Country:US
Mailing Address - Phone:262-478-0033
Mailing Address - Fax:262-478-0035
Practice Address - Street 1:1516 W MEQUON RD
Practice Address - Street 2:SUITE 202
Practice Address - City:MEQUON
Practice Address - State:WI
Practice Address - Zip Code:53092-3264
Practice Address - Country:US
Practice Address - Phone:262-478-0033
Practice Address - Fax:262-478-0035
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-06
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI3524012111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WIU72107Medicare UPIN