Provider Demographics
NPI:1528122611
Name:CHIROPRACTIC COMPANY - WEST ALLIS LTD
Entity type:Organization
Organization Name:CHIROPRACTIC COMPANY - WEST ALLIS LTD
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:P
Authorized Official - Last Name:CORSI
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:414-327-6767
Mailing Address - Street 1:2255 S 108TH ST
Mailing Address - Street 2:
Mailing Address - City:WEST ALLIS
Mailing Address - State:WI
Mailing Address - Zip Code:53227-1107
Mailing Address - Country:US
Mailing Address - Phone:414-327-6767
Mailing Address - Fax:414-327-0988
Practice Address - Street 1:2255 S 108TH ST
Practice Address - Street 2:
Practice Address - City:WEST ALLIS
Practice Address - State:WI
Practice Address - Zip Code:53227-1107
Practice Address - Country:US
Practice Address - Phone:414-327-6767
Practice Address - Fax:414-327-0988
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CHIROPRACTIC COMPANY S.C.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-12-21
Last Update Date:2019-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1341012111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI000075481Medicare ID - Type Unspecified
T62354Medicare UPIN