Provider Demographics
NPI:1982720868
Name:PERDZIAK CHIROPRACTIC OFFICE, S.C.
Entity Type:Organization
Organization Name:PERDZIAK CHIROPRACTIC OFFICE, S.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:ANDREW
Authorized Official - Last Name:PERDZIAK
Authorized Official - Suffix:
Authorized Official - Credentials:DC, DABCO
Authorized Official - Phone:262-646-2640
Mailing Address - Street 1:19 CROSSROADS CT.
Mailing Address - Street 2:SUITE 101
Mailing Address - City:DELAFIELD
Mailing Address - State:WI
Mailing Address - Zip Code:53018-2035
Mailing Address - Country:US
Mailing Address - Phone:262-646-2640
Mailing Address - Fax:262-646-2650
Practice Address - Street 1:19 CROSSROADS CT.
Practice Address - Street 2:SUITE 101
Practice Address - City:DELAFIELD
Practice Address - State:WI
Practice Address - Zip Code:53018-2035
Practice Address - Country:US
Practice Address - Phone:262-646-2640
Practice Address - Fax:262-646-2650
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-22
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1306-012111NX0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NX0800XChiropractic ProvidersChiropractorOrthopedicGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI75457Medicare ID - Type Unspecified