Provider Demographics
NPI:1194934521
Name:TRUHLSEN CHIROPRACTIC, S.C.
Entity type:Organization
Organization Name:TRUHLSEN CHIROPRACTIC, S.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DWAYNE
Authorized Official - Middle Name:KEITH
Authorized Official - Last Name:TRUHLSEN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:715-755-2583
Mailing Address - Street 1:PO BOX 186
Mailing Address - Street 2:
Mailing Address - City:DRESSER
Mailing Address - State:WI
Mailing Address - Zip Code:54009-0186
Mailing Address - Country:US
Mailing Address - Phone:715-755-2583
Mailing Address - Fax:715-755-2573
Practice Address - Street 1:115 NO. STATE HWY 35
Practice Address - Street 2:
Practice Address - City:DRESSER
Practice Address - State:WI
Practice Address - Zip Code:54009
Practice Address - Country:US
Practice Address - Phone:715-755-2583
Practice Address - Fax:715-755-2573
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-22
Last Update Date:2022-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI3482111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI38905900Medicaid
WI70645Medicare ID - Type Unspecified