Provider Demographics
NPI:1063577666
Name:BORAK, STEPHEN JOSEPH (DC)
Entity type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:JOSEPH
Last Name:BORAK
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 665
Mailing Address - Street 2:190 HWY 70
Mailing Address - City:SAINT GERMAIN
Mailing Address - State:WI
Mailing Address - Zip Code:54558-0665
Mailing Address - Country:US
Mailing Address - Phone:715-479-3261
Mailing Address - Fax:715-479-6295
Practice Address - Street 1:190 HIGHWAY 70
Practice Address - Street 2:
Practice Address - City:SAINT GERMAIN
Practice Address - State:WI
Practice Address - Zip Code:54558-0665
Practice Address - Country:US
Practice Address - Phone:715-479-3261
Practice Address - Fax:715-479-6295
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-26
Last Update Date:2023-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2760111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI38860900Medicaid
WI38860900Medicaid
WIU25838Medicare UPIN