Provider Demographics
NPI:1063618502
Name:KEWAUNEE CHIROPRACTIC WORKS LLC
Entity type:Organization
Organization Name:KEWAUNEE CHIROPRACTIC WORKS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:REYNE
Authorized Official - Middle Name:J
Authorized Official - Last Name:PETERS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:920-388-0285
Mailing Address - Street 1:224 ELLIS ST
Mailing Address - Street 2:
Mailing Address - City:KEWAUNEE
Mailing Address - State:WI
Mailing Address - Zip Code:54216-1006
Mailing Address - Country:US
Mailing Address - Phone:920-388-0285
Mailing Address - Fax:920-388-0291
Practice Address - Street 1:224 ELLIS ST
Practice Address - Street 2:
Practice Address - City:KEWAUNEE
Practice Address - State:WI
Practice Address - Zip Code:54216-1006
Practice Address - Country:US
Practice Address - Phone:920-388-0285
Practice Address - Fax:920-388-0291
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-22
Last Update Date:2024-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI3480111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
000035569Medicare ID - Type Unspecified
WIU69757Medicare UPIN