Provider Demographics
NPI:1427457514
Name:CHIROPRACTIC PLACE LLC
Entity type:Organization
Organization Name:CHIROPRACTIC PLACE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:J
Authorized Official - Last Name:ANDERSON
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:608-269-4511
Mailing Address - Street 1:415 W WISCONSIN ST
Mailing Address - Street 2:STE 4
Mailing Address - City:SPARTA
Mailing Address - State:WI
Mailing Address - Zip Code:54656-2492
Mailing Address - Country:US
Mailing Address - Phone:608-269-4511
Mailing Address - Fax:608-269-8511
Practice Address - Street 1:415 W WISCONSIN ST
Practice Address - Street 2:STE 4
Practice Address - City:SPARTA
Practice Address - State:WI
Practice Address - Zip Code:54656-2492
Practice Address - Country:US
Practice Address - Phone:608-269-4511
Practice Address - Fax:608-269-8511
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-08-14
Last Update Date:2014-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty