Provider Demographics
NPI:1588717292
Name:MILWAUKEE CHIROPRACTIC GROUP, LLC
Entity type:Organization
Organization Name:MILWAUKEE CHIROPRACTIC GROUP, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ANTHONY
Authorized Official - Middle Name:CARL
Authorized Official - Last Name:RINALDI
Authorized Official - Suffix:JR
Authorized Official - Credentials:DC
Authorized Official - Phone:262-560-4977
Mailing Address - Street 1:W359N5920 BROWN ST
Mailing Address - Street 2:
Mailing Address - City:OCONOMOWOC
Mailing Address - State:WI
Mailing Address - Zip Code:53066-2488
Mailing Address - Country:US
Mailing Address - Phone:262-560-4977
Mailing Address - Fax:775-599-9575
Practice Address - Street 1:W359N5920 BROWN ST
Practice Address - Street 2:
Practice Address - City:OCONOMOWOC
Practice Address - State:WI
Practice Address - Zip Code:53066-2488
Practice Address - Country:US
Practice Address - Phone:262-560-4977
Practice Address - Fax:775-599-9575
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-18
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI4011-012111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty