Healthcare Provider Details

I. General information

NPI: 1346397783
Provider Name (Legal Business Name): CHIROPRACTIC COMPANY - 23 LTD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/05/2007
Last Update Date: 09/24/2024
Certification Date: 09/24/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1905 N CALHOUN RD STE 115
BROOKFIELD WI
53005-5036
US

IV. Provider business mailing address

11131 N WAUWATOSA RD
MEQUON WI
53097-3431
US

V. Phone/Fax

Practice location:
  • Phone: 262-782-2273
  • Fax: 262-257-9966
Mailing address:
  • Phone: 414-354-5377
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number2181
License Number StateWI

VIII. Authorized Official

Name: JOHN P CORSI
Title or Position: CFO
Credential: DC
Phone: 414-354-5377