Provider Demographics
NPI:1720477540
Name:NORTHSIDE CHIROPRACTIC CENTER LLC
Entity type:Organization
Organization Name:NORTHSIDE CHIROPRACTIC CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:
Authorized Official - First Name:BRADLEY
Authorized Official - Middle Name:
Authorized Official - Last Name:HUNTER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:920-573-0400
Mailing Address - Street 1:PO BOX 883
Mailing Address - Street 2:
Mailing Address - City:OSHKOSH
Mailing Address - State:WI
Mailing Address - Zip Code:54903-0883
Mailing Address - Country:US
Mailing Address - Phone:920-573-0400
Mailing Address - Fax:920-744-1442
Practice Address - Street 1:2337A JACKSON ST
Practice Address - Street 2:
Practice Address - City:OSHKOSH
Practice Address - State:WI
Practice Address - Zip Code:54901-1809
Practice Address - Country:US
Practice Address - Phone:920-573-0400
Practice Address - Fax:920-744-1442
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-01-16
Last Update Date:2015-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI4307-012111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty