Provider Demographics
NPI:1962578658
Name:COLEMAN CHIROPRACTIC CENTER, LLC
Entity type:Organization
Organization Name:COLEMAN CHIROPRACTIC CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:JASON
Authorized Official - Middle Name:
Authorized Official - Last Name:GRAETZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:920-897-4566
Mailing Address - Street 1:205 N PARK AVE
Mailing Address - Street 2:
Mailing Address - City:COLEMAN
Mailing Address - State:WI
Mailing Address - Zip Code:54112-9438
Mailing Address - Country:US
Mailing Address - Phone:920-897-4566
Mailing Address - Fax:
Practice Address - Street 1:205 N PARK AVE
Practice Address - Street 2:
Practice Address - City:COLEMAN
Practice Address - State:WI
Practice Address - Zip Code:54112-9438
Practice Address - Country:US
Practice Address - Phone:920-897-4566
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-27
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI3681-012111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty