Provider Demographics
NPI:1699282632
Name:ASCENT CHIROPRACTIC LLC
Entity type:Organization
Organization Name:ASCENT CHIROPRACTIC LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:GRANT
Authorized Official - Middle Name:KEITH
Authorized Official - Last Name:RADERMACHER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:262-345-4166
Mailing Address - Street 1:16620 W BLUEMOUND RD # 405
Mailing Address - Street 2:
Mailing Address - City:BROOKFIELD
Mailing Address - State:WI
Mailing Address - Zip Code:53005-5966
Mailing Address - Country:US
Mailing Address - Phone:262-345-4166
Mailing Address - Fax:262-753-6908
Practice Address - Street 1:16620 W BLUEMOUND RD # 405
Practice Address - Street 2:
Practice Address - City:BROOKFIELD
Practice Address - State:WI
Practice Address - Zip Code:53005-5966
Practice Address - Country:US
Practice Address - Phone:262-345-4166
Practice Address - Fax:262-753-6908
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-12-29
Last Update Date:2017-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI4707-12111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty