Provider Demographics
NPI:1982734265
Name:LITANG CHIROPRACTIC SC
Entity Type:Organization
Organization Name:LITANG CHIROPRACTIC SC
Other - Org Name:LITANG FAMILY CHIROPRACTIC SC
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:SANDRA
Authorized Official - Middle Name:CARMEN
Authorized Official - Last Name:CANON
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:608-655-4164
Mailing Address - Street 1:131 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:MARSHALL
Mailing Address - State:WI
Mailing Address - Zip Code:53559-9377
Mailing Address - Country:US
Mailing Address - Phone:608-655-4164
Mailing Address - Fax:
Practice Address - Street 1:131 E MAIN ST
Practice Address - Street 2:
Practice Address - City:MARSHALL
Practice Address - State:WI
Practice Address - Zip Code:53559-9377
Practice Address - Country:US
Practice Address - Phone:608-655-4164
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-06
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI3185111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI38996300Medicaid
WI38996300Medicaid