Provider Demographics
NPI:1962425355
Name:BADGER CHIROPRACTIC, LLC
Entity type:Organization
Organization Name:BADGER CHIROPRACTIC, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:JARED
Authorized Official - Middle Name:D
Authorized Official - Last Name:HOLTHE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:608-848-2638
Mailing Address - Street 1:6386 PHEASANT LN
Mailing Address - Street 2:
Mailing Address - City:VERONA
Mailing Address - State:WI
Mailing Address - Zip Code:53593-9258
Mailing Address - Country:US
Mailing Address - Phone:608-848-2638
Mailing Address - Fax:
Practice Address - Street 1:6384 PHEASANT LN
Practice Address - Street 2:
Practice Address - City:VERONA
Practice Address - State:WI
Practice Address - Zip Code:53593-9258
Practice Address - Country:US
Practice Address - Phone:608-848-2638
Practice Address - Fax:608-848-2638
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-26
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI3554-012111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty