Provider Demographics
NPI:1811431539
Name:ELKHORN FAMILY CHIROPRACTIC LLC
Entity type:Organization
Organization Name:ELKHORN FAMILY CHIROPRACTIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:KATHLEEN
Authorized Official - Middle Name:D
Authorized Official - Last Name:HANSEN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:262-949-6407
Mailing Address - Street 1:9 N WISCONSIN ST
Mailing Address - Street 2:
Mailing Address - City:ELKHORN
Mailing Address - State:WI
Mailing Address - Zip Code:53121-1737
Mailing Address - Country:US
Mailing Address - Phone:262-379-1800
Mailing Address - Fax:262-379-1801
Practice Address - Street 1:9 N WISCONSIN ST
Practice Address - Street 2:
Practice Address - City:ELKHORN
Practice Address - State:WI
Practice Address - Zip Code:53121-1737
Practice Address - Country:US
Practice Address - Phone:262-379-1800
Practice Address - Fax:262-379-1801
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-12-14
Last Update Date:2016-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI5190-12111NX0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NX0800XChiropractic ProvidersChiropractorOrthopedicGroup - Single Specialty