Provider Demographics
NPI:1720268808
Name:QUEST CHIROPRACTIC LLC
Entity type:Organization
Organization Name:QUEST CHIROPRACTIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR OF CHIROPRACTIC
Authorized Official - Prefix:DR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:W
Authorized Official - Last Name:KREBSBACH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:920-497-8378
Mailing Address - Street 1:2337 S RIDGE RD
Mailing Address - Street 2:SUITE B
Mailing Address - City:GREEN BAY
Mailing Address - State:WI
Mailing Address - Zip Code:54304-5857
Mailing Address - Country:US
Mailing Address - Phone:922-049-7837
Mailing Address - Fax:920-498-8368
Practice Address - Street 1:2337 S RIDGE RD
Practice Address - Street 2:SUITE B
Practice Address - City:GREEN BAY
Practice Address - State:WI
Practice Address - Zip Code:54304-5857
Practice Address - Country:US
Practice Address - Phone:922-049-7837
Practice Address - Fax:920-498-8368
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-06
Last Update Date:2007-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI3966-012111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WIV03893Medicare UPIN