Provider Demographics
NPI:1831350602
Name:GENESIS CHIROPRACTIC CENTER, S.C.
Entity type:Organization
Organization Name:GENESIS CHIROPRACTIC CENTER, S.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DR
Authorized Official - Prefix:DR
Authorized Official - First Name:CURTIS
Authorized Official - Middle Name:KARL
Authorized Official - Last Name:KRANTZ
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:608-836-8080
Mailing Address - Street 1:8333 GREENWAY BLVD
Mailing Address - Street 2:SUITE 140
Mailing Address - City:MIDDLETON
Mailing Address - State:WI
Mailing Address - Zip Code:53562-3684
Mailing Address - Country:US
Mailing Address - Phone:608-836-8080
Mailing Address - Fax:608-836-8010
Practice Address - Street 1:8333 GREENWAY BLVD
Practice Address - Street 2:SUITE 140
Practice Address - City:MIDDLETON
Practice Address - State:WI
Practice Address - Zip Code:53562-3684
Practice Address - Country:US
Practice Address - Phone:608-836-8080
Practice Address - Fax:608-836-8010
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-24
Last Update Date:2009-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI3395111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI0000155510Medicare PIN