Healthcare Provider Details

I. General information

NPI: 1730130451
Provider Name (Legal Business Name): MAIN STREET CHIROPRACTIC LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/15/2006
Last Update Date: 10/12/2021
Certification Date: 10/12/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

106 S MADISON ST
WAUNAKEE WI
53597-2427
US

IV. Provider business mailing address

106 S MADISON ST
WAUNAKEE WI
53597-2427
US

V. Phone/Fax

Practice location:
  • Phone: 608-849-8600
  • Fax: 608-849-8838
Mailing address:
  • Phone: 608-849-8600
  • Fax: 608-849-8838

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: MRS. HEIDI LEAH SCHLAPPI
Title or Position: OWER
Credential: D.C.
Phone: 608-849-8600