Provider Demographics
NPI:1083700561
Name:BARABOO CHIROPRACTIC OFFICE INC
Entity type:Organization
Organization Name:BARABOO CHIROPRACTIC OFFICE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:M
Authorized Official - Last Name:WITTERS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:608-356-2127
Mailing Address - Street 1:1030 8TH ST
Mailing Address - Street 2:
Mailing Address - City:BARABOO
Mailing Address - State:WI
Mailing Address - Zip Code:53913-1850
Mailing Address - Country:US
Mailing Address - Phone:608-356-2127
Mailing Address - Fax:608-356-1292
Practice Address - Street 1:1030 8TH ST
Practice Address - Street 2:
Practice Address - City:BARABOO
Practice Address - State:WI
Practice Address - Zip Code:53913-1850
Practice Address - Country:US
Practice Address - Phone:608-356-2127
Practice Address - Fax:608-356-1292
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-04
Last Update Date:2014-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1559-012111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI=========OtherTAX ID