Provider Demographics
NPI:1932351632
Name:CHAIN O' LAKES CHIROPRACTIC, LLC
Entity Type:Organization
Organization Name:CHAIN O' LAKES CHIROPRACTIC, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CHAD
Authorized Official - Middle Name:ALAN
Authorized Official - Last Name:CLOUTIER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:715-258-2800
Mailing Address - Street 1:830 SCHOOL ST
Mailing Address - Street 2:
Mailing Address - City:WAUPACA
Mailing Address - State:WI
Mailing Address - Zip Code:54981-1633
Mailing Address - Country:US
Mailing Address - Phone:715-258-2800
Mailing Address - Fax:715-258-2885
Practice Address - Street 1:830 SCHOOL ST
Practice Address - Street 2:
Practice Address - City:WAUPACA
Practice Address - State:WI
Practice Address - Zip Code:54981-1633
Practice Address - Country:US
Practice Address - Phone:715-258-2800
Practice Address - Fax:715-258-2885
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-14
Last Update Date:2014-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty