Provider Demographics
NPI:1720101124
Name:BULA CHIROPRACTIC LLC
Entity type:Organization
Organization Name:BULA CHIROPRACTIC LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:STACY
Authorized Official - Middle Name:M
Authorized Official - Last Name:BULA
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:715-623-1191
Mailing Address - Street 1:537 FIELD ST
Mailing Address - Street 2:
Mailing Address - City:ANTIGO
Mailing Address - State:WI
Mailing Address - Zip Code:54409-2229
Mailing Address - Country:US
Mailing Address - Phone:715-623-1191
Mailing Address - Fax:715-623-1191
Practice Address - Street 1:537 FIELD ST
Practice Address - Street 2:
Practice Address - City:ANTIGO
Practice Address - State:WI
Practice Address - Zip Code:54409-2229
Practice Address - Country:US
Practice Address - Phone:715-623-1191
Practice Address - Fax:715-623-1191
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-09
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI301035111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI38939200Medicaid
WI38939200Medicaid