Healthcare Provider Details

I. General information

NPI: 1073694477
Provider Name (Legal Business Name): THE CHIROPRACTORS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/18/2006
Last Update Date: 09/28/2020
Certification Date: 09/28/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

690 WESTFIELD WAY STE F
PEWAUKEE WI
53072-2585
US

IV. Provider business mailing address

690 WESTFIELD WAY STE F
PEWAUKEE WI
53072-2585
US

V. Phone/Fax

Practice location:
  • Phone: 262-691-0997
  • Fax: 262-875-3593
Mailing address:
  • Phone: 262-691-0997
  • Fax: 262-875-3593

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number4172-012
License Number StateWI

VIII. Authorized Official

Name: DR. CHRISTOPHER PAUL REBHOLZ
Title or Position: OWNER
Credential: D.C.
Phone: 262-691-0997