Provider Demographics
NPI:1215146840
Name:CHIRO HEALTH CLINIC SC
Entity type:Organization
Organization Name:CHIRO HEALTH CLINIC SC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER SHAREHOLDER
Authorized Official - Prefix:DR
Authorized Official - First Name:JER
Authorized Official - Middle Name:
Authorized Official - Last Name:LEE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:920-435-7575
Mailing Address - Street 1:122 S WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:GREEN BAY
Mailing Address - State:WI
Mailing Address - Zip Code:54301-4211
Mailing Address - Country:US
Mailing Address - Phone:920-435-7575
Mailing Address - Fax:920-435-7574
Practice Address - Street 1:122 S WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:GREEN BAY
Practice Address - State:WI
Practice Address - Zip Code:54301-4211
Practice Address - Country:US
Practice Address - Phone:920-435-7575
Practice Address - Fax:920-435-7574
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-21
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI4252111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty