Provider Demographics
NPI:1831363431
Name:HOWARD CHIROPRACTIC CLINIC, S.C.
Entity type:Organization
Organization Name:HOWARD CHIROPRACTIC CLINIC, S.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DENNIS
Authorized Official - Middle Name:
Authorized Official - Last Name:KING
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:920-434-2221
Mailing Address - Street 1:721 CARDINAL LN
Mailing Address - Street 2:STE 100
Mailing Address - City:GREEN BAY
Mailing Address - State:WI
Mailing Address - Zip Code:54313-3216
Mailing Address - Country:US
Mailing Address - Phone:920-434-2221
Mailing Address - Fax:920-434-2483
Practice Address - Street 1:721 CARDINAL LN
Practice Address - Street 2:STE 100
Practice Address - City:GREEN BAY
Practice Address - State:WI
Practice Address - Zip Code:54313-3216
Practice Address - Country:US
Practice Address - Phone:920-434-2221
Practice Address - Fax:920-434-2483
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-15
Last Update Date:2012-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI3015111NP0017X
WI4133111NR0400X
WI2312111NX0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NX0800XChiropractic ProvidersChiropractorOrthopedicGroup - Multi-Specialty
No111NP0017XChiropractic ProvidersChiropractorPediatric ChiropractorGroup - Multi-Specialty
No111NR0400XChiropractic ProvidersChiropractorRehabilitationGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
170970Medicare PIN
270970Medicare PIN
470970Medicare PIN