Healthcare Provider Details

I. General information

NPI: 1952647802
Provider Name (Legal Business Name): CHIROPRACTIC COMPANY - THIRD WARD LTD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/21/2012
Last Update Date: 12/19/2019
Certification Date: 12/19/2019
Deactivation Date:
Reactivation Date:

III. Provider practice location address

140 S 1ST ST STE 101
MILWAUKEE WI
53204-4317
US

IV. Provider business mailing address

140 S 1ST ST STE 101
MILWAUKEE WI
53204-4317
US

V. Phone/Fax

Practice location:
  • Phone: 414-271-1717
  • Fax: 414-271-1727
Mailing address:
  • Phone: 414-271-1717
  • Fax: 414-271-1727

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number
License Number State

VIII. Authorized Official

Name: DR. JOHN CORSI
Title or Position: PARTNER
Credential: DC
Phone: 414-354-5377