Provider Demographics
NPI:1215936141
Name:DOWNTOWN CHIROPRACTIC HEALTH & SPORTS INJURY CLINIC
Entity type:Organization
Organization Name:DOWNTOWN CHIROPRACTIC HEALTH & SPORTS INJURY CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:
Authorized Official - Last Name:LANG
Authorized Official - Suffix:III
Authorized Official - Credentials:DC
Authorized Official - Phone:414-272-7250
Mailing Address - Street 1:732 N JACKSON ST STE 150
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53202-4605
Mailing Address - Country:US
Mailing Address - Phone:414-272-7250
Mailing Address - Fax:414-272-7107
Practice Address - Street 1:600 E MASON ST
Practice Address - Street 2:STE 100
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53202-3870
Practice Address - Country:US
Practice Address - Phone:414-272-7250
Practice Address - Fax:414-272-7107
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-21
Last Update Date:2020-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2533012111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI38850000Medicaid
WI38850000Medicaid