Provider Demographics
NPI:1215058748
Name:METRO CHIROPRACTIC CLINIC, S.C.
Entity type:Organization
Organization Name:METRO CHIROPRACTIC CLINIC, S.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MARY
Authorized Official - Middle Name:JANE-SHNOWSKE
Authorized Official - Last Name:METROPULOS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:715-693-8111
Mailing Address - Street 1:PO BOX 113
Mailing Address - Street 2:
Mailing Address - City:MOSINEE
Mailing Address - State:WI
Mailing Address - Zip Code:54455-0113
Mailing Address - Country:US
Mailing Address - Phone:715-693-8111
Mailing Address - Fax:715-692-2529
Practice Address - Street 1:309 4TH ST
Practice Address - Street 2:
Practice Address - City:MOSINEE
Practice Address - State:WI
Practice Address - Zip Code:54455-1109
Practice Address - Country:US
Practice Address - Phone:715-693-8111
Practice Address - Fax:715-692-2529
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-02
Last Update Date:2009-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI3192111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI000035852Medicare PIN