Provider Demographics
NPI:1285910422
Name:GENERATIONS CHIROPRACTIC AND WELLNESS LLC
Entity type:Organization
Organization Name:GENERATIONS CHIROPRACTIC AND WELLNESS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:
Authorized Official - Last Name:KOLANDER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:608-781-9555
Mailing Address - Street 1:826 2ND AVE N
Mailing Address - Street 2:
Mailing Address - City:ONALASKA
Mailing Address - State:WI
Mailing Address - Zip Code:54650-2208
Mailing Address - Country:US
Mailing Address - Phone:608-781-9555
Mailing Address - Fax:
Practice Address - Street 1:826 2ND AVE N
Practice Address - Street 2:
Practice Address - City:ONALASKA
Practice Address - State:WI
Practice Address - Zip Code:54650-2208
Practice Address - Country:US
Practice Address - Phone:608-781-9555
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-11-02
Last Update Date:2012-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI3537-012111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WIWI2648OtherMEDICARE