Provider Demographics
NPI:1538228374
Name:NIEDERMANN CHIROPRACTIC S.C.
Entity type:Organization
Organization Name:NIEDERMANN CHIROPRACTIC S.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:KARL
Authorized Official - Middle Name:ANTHONY
Authorized Official - Last Name:NIEDERMANN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:920-731-2434
Mailing Address - Street 1:324 W WISCONSIN AVE
Mailing Address - Street 2:SUITE B
Mailing Address - City:APPLETON
Mailing Address - State:WI
Mailing Address - Zip Code:54911-4327
Mailing Address - Country:US
Mailing Address - Phone:920-731-2434
Mailing Address - Fax:920-731-8007
Practice Address - Street 1:324 W WISCONSIN AVE
Practice Address - Street 2:SUITE B
Practice Address - City:APPLETON
Practice Address - State:WI
Practice Address - Zip Code:54911-4327
Practice Address - Country:US
Practice Address - Phone:920-731-2434
Practice Address - Fax:920-731-8007
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-07
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1803261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center