Provider Demographics
NPI:1972793578
Name:FAMILY CHIROPRACTIC HEALTH CENTER
Entity type:Organization
Organization Name:FAMILY CHIROPRACTIC HEALTH CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CHERYL
Authorized Official - Middle Name:C
Authorized Official - Last Name:FOLSTAD
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:608-372-2747
Mailing Address - Street 1:1100 KILBOURN AVE
Mailing Address - Street 2:
Mailing Address - City:TOMAH
Mailing Address - State:WI
Mailing Address - Zip Code:54660-2630
Mailing Address - Country:US
Mailing Address - Phone:608-372-2747
Mailing Address - Fax:608-372-3100
Practice Address - Street 1:1100 KILBOURN AVE
Practice Address - Street 2:
Practice Address - City:TOMAH
Practice Address - State:WI
Practice Address - Zip Code:54660-2630
Practice Address - Country:US
Practice Address - Phone:608-372-2747
Practice Address - Fax:608-372-3100
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-30
Last Update Date:2007-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1875-012111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WIT61925OtherUPIN
WI000075472Medicare PIN