Provider Demographics
NPI:1306176813
Name:BLUE RIVER CHIROPRACTIC LLC
Entity type:Organization
Organization Name:BLUE RIVER CHIROPRACTIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:BENJAMIN
Authorized Official - Middle Name:JACOB
Authorized Official - Last Name:ZAHASKY
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:608-335-0842
Mailing Address - Street 1:346 JUNCTION RD
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:WI
Mailing Address - Zip Code:53717-2612
Mailing Address - Country:US
Mailing Address - Phone:608-335-0842
Mailing Address - Fax:608-831-4519
Practice Address - Street 1:346 JUNCTION RD
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53717-2612
Practice Address - Country:US
Practice Address - Phone:608-335-0842
Practice Address - Fax:608-831-4519
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-01-05
Last Update Date:2010-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI4569012111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty