Provider Demographics
NPI:1831581891
Name:CHIROPRACTIC FIRST OF DELAFIELD LLC
Entity type:Organization
Organization Name:CHIROPRACTIC FIRST OF DELAFIELD LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR OF CHIROPRACTIC
Authorized Official - Prefix:DR
Authorized Official - First Name:BEAU
Authorized Official - Middle Name:
Authorized Official - Last Name:BANTON
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:262-303-4865
Mailing Address - Street 1:2728 HILLSIDE DR
Mailing Address - Street 2:
Mailing Address - City:DELAFIELD
Mailing Address - State:WI
Mailing Address - Zip Code:53018-2164
Mailing Address - Country:US
Mailing Address - Phone:262-303-4865
Mailing Address - Fax:
Practice Address - Street 1:2728 HILLSIDE DR
Practice Address - Street 2:
Practice Address - City:DELAFIELD
Practice Address - State:WI
Practice Address - Zip Code:53018-2164
Practice Address - Country:US
Practice Address - Phone:262-303-4865
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-02-28
Last Update Date:2015-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI4741-12111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty