MEDICARE: ONALASKA CHIROPRACTIC, S.C.

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	4553-12	WI

General Provider Information

NPI Number	:	1881919538
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ONALASKA CHIROPRACTIC, S.C.

Provider Business Mailing Address
First Line	:	704 SAND LAKE RD
Second Line	:
City	:	ONALASKA
State	:	WI
Zip	:	54650-2400
Country	:	US
Telephone Number	:	608-799-2911
Fax Number	:

Provider Business Practice Location Address
First Line	:	704 SAND LAKE RD
Second Line	:
City	:	ONALASKA
State	:	WI
Zip	:	54650-2400
Country	:	US
Telephone Number	:	608-799-2911
Fax Number	:

Authorized Official
Title or Position	:	OWNER/DOCTOR
Name	:	DR. STUART WILLIAM LEINBACH
Credential	:	D.C.
Telephone Number	:	608-799-2911

Provider Enumeration Date	:	04/06/2010
Last Update Date	:	04/06/2010

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