MEDICARE: PARK PLACE CHIROPRACTIC, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor	4035-012	WI
2	111NS0005X	Sports Physician Chiropractor	4035-012	WI

General Provider Information

NPI Number	:	1205961331
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PARK PLACE CHIROPRACTIC, LLC

Provider Business Mailing Address
First Line	:	1831 W COURT ST
Second Line	:
City	:	JANESVILLE
State	:	WI
Zip	:	53548-3406
Country	:	US
Telephone Number	:	608-754-7463
Fax Number	:	608-754-1437

Provider Business Practice Location Address
First Line	:	1831 W COURT ST
Second Line	:
City	:	JANESVILLE
State	:	WI
Zip	:	53548-3406
Country	:	US
Telephone Number	:	608-754-7463
Fax Number	:	608-754-1437

Authorized Official
Title or Position	:	CHIROPRACTOR
Name	:	DR. ANDREW PAULL
Credential	:	D.C.
Telephone Number	:	608-754-7463

Provider Enumeration Date	:	02/22/2007
Last Update Date	:	09/11/2025

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