Provider Demographics
NPI:1841479094
Name:PROGRESSIVE CHIROPRACTIC, S.C.
Entity type:Organization
Organization Name:PROGRESSIVE CHIROPRACTIC, S.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:VICTORIA
Authorized Official - Middle Name:LYN
Authorized Official - Last Name:BOWE-FISHER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:262-251-0340
Mailing Address - Street 1:N112W15800 MEQUON RD
Mailing Address - Street 2:
Mailing Address - City:GERMANTOWN
Mailing Address - State:WI
Mailing Address - Zip Code:53022-3389
Mailing Address - Country:US
Mailing Address - Phone:262-251-0340
Mailing Address - Fax:262-437-1337
Practice Address - Street 1:N112W15800 MEQUON RD
Practice Address - Street 2:
Practice Address - City:GERMANTOWN
Practice Address - State:WI
Practice Address - Zip Code:53022-3389
Practice Address - Country:US
Practice Address - Phone:262-251-0340
Practice Address - Fax:262-437-1337
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-24
Last Update Date:2007-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2428261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI2428OtherSTATE LICENSE
WIU25318Medicare UPIN