Healthcare Provider Details

I. General information

NPI: 1265884928
Provider Name (Legal Business Name): CHIROPRACTIC COMPANY - OCONOMOWOC LTD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/06/2016
Last Update Date: 08/25/2025
Certification Date: 08/25/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1300 N SUMMIT AVE STE 201
OCONOMOWOC WI
53066-4467
US

IV. Provider business mailing address

1300 N SUMMIT AVE STE 201
OCONOMOWOC WI
53066-4467
US

V. Phone/Fax

Practice location:
  • Phone: 262-244-5004
  • Fax: 262-257-9966
Mailing address:
  • Phone: 262-244-5004
  • Fax: 262-257-9966

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number
License Number State

VIII. Authorized Official

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