Provider Demographics
NPI:1912061987
Name:ELITE CHIROPRACTIC ANTIGO SC
Entity Type:Organization
Organization Name:ELITE CHIROPRACTIC ANTIGO SC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ASSOCIATE DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:PAUL
Authorized Official - Last Name:VESELAK
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:715-623-4800
Mailing Address - Street 1:239 SUPERIOR ST
Mailing Address - Street 2:
Mailing Address - City:ANTIGO
Mailing Address - State:WI
Mailing Address - Zip Code:54409-1860
Mailing Address - Country:US
Mailing Address - Phone:715-623-4800
Mailing Address - Fax:715-623-6466
Practice Address - Street 1:239 SUPERIOR ST
Practice Address - Street 2:
Practice Address - City:ANTIGO
Practice Address - State:WI
Practice Address - Zip Code:54409-1860
Practice Address - Country:US
Practice Address - Phone:715-623-4800
Practice Address - Fax:715-623-6466
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-21
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI4160-012111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WIU68141Medicare UPIN