Provider Demographics
NPI:1093539173
Name:CHIROPRACTIC HEALTH CENTER OF WAUPACA LLC, STUART BOELTE SOLE MBR
Entity type:Organization
Organization Name:CHIROPRACTIC HEALTH CENTER OF WAUPACA LLC, STUART BOELTE SOLE MBR
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:STUART
Authorized Official - Middle Name:JOHN
Authorized Official - Last Name:BOELTE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:715-258-8288
Mailing Address - Street 1:1326 ROYALTON ST
Mailing Address - Street 2:
Mailing Address - City:WAUPACA
Mailing Address - State:WI
Mailing Address - Zip Code:54981-1609
Mailing Address - Country:US
Mailing Address - Phone:715-258-8288
Mailing Address - Fax:715-258-7195
Practice Address - Street 1:1326 ROYALTON ST
Practice Address - Street 2:
Practice Address - City:WAUPACA
Practice Address - State:WI
Practice Address - Zip Code:54981-1609
Practice Address - Country:US
Practice Address - Phone:715-258-8288
Practice Address - Fax:715-258-7195
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-11-14
Last Update Date:2024-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty