Provider Demographics
NPI:1962284059
Name:MANITOWOC CHIROPRACTIC LLC
Entity type:Organization
Organization Name:MANITOWOC CHIROPRACTIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:JOHN
Authorized Official - Last Name:PORTMANN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:920-683-3800
Mailing Address - Street 1:1 E WALDO BLVD STE 1
Mailing Address - Street 2:
Mailing Address - City:MANITOWOC
Mailing Address - State:WI
Mailing Address - Zip Code:54220-2912
Mailing Address - Country:US
Mailing Address - Phone:920-683-3800
Mailing Address - Fax:920-683-1230
Practice Address - Street 1:1 E WALDO BLVD STE 1
Practice Address - Street 2:
Practice Address - City:MANITOWOC
Practice Address - State:WI
Practice Address - Zip Code:54220-2912
Practice Address - Country:US
Practice Address - Phone:920-683-3800
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-10-16
Last Update Date:2024-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty