Provider Demographics
NPI:1528290798
Name:ELK MOUND CHIROPRACTIC LLC
Entity type:Organization
Organization Name:ELK MOUND CHIROPRACTIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROVIDER/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:EDWARD
Authorized Official - Middle Name:PAUL
Authorized Official - Last Name:RYGIEL
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:715-879-4480
Mailing Address - Street 1:205 W MENOMONIE ST
Mailing Address - Street 2:
Mailing Address - City:ELK MOUND
Mailing Address - State:WI
Mailing Address - Zip Code:54739-9520
Mailing Address - Country:US
Mailing Address - Phone:715-879-4480
Mailing Address - Fax:715-879-4490
Practice Address - Street 1:205 W MENOMONIE ST
Practice Address - Street 2:
Practice Address - City:ELK MOUND
Practice Address - State:WI
Practice Address - Zip Code:54739-9520
Practice Address - Country:US
Practice Address - Phone:715-879-4480
Practice Address - Fax:715-879-4490
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-08-20
Last Update Date:2009-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI4513-012111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI1063640662Medicaid