Provider Demographics
NPI:1124740246
Name:CHIRO ONE WELLNESS CENTER OF SUN PRAIRIE LLC
Entity type:Organization
Organization Name:CHIRO ONE WELLNESS CENTER OF SUN PRAIRIE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DC
Authorized Official - Prefix:
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:
Authorized Official - Last Name:FRAHM
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:630-229-4430
Mailing Address - Street 1:PO BOX 74008519 PMB 1352
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60674-0001
Mailing Address - Country:US
Mailing Address - Phone:630-468-1824
Mailing Address - Fax:
Practice Address - Street 1:695 S GRAND AVE STE 103
Practice Address - Street 2:
Practice Address - City:SUN PRAIRIE
Practice Address - State:WI
Practice Address - Zip Code:53590-9722
Practice Address - Country:US
Practice Address - Phone:608-688-0911
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-09-15
Last Update Date:2022-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty