Healthcare Provider Details

I. General information

NPI: 1366759979
Provider Name (Legal Business Name): WHITEWATER CHIROPRACTIC, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/02/2010
Last Update Date: 09/02/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

214 S 2ND ST APT 101
WHITEWATER WI
53190-2083
US

IV. Provider business mailing address

214 S 2ND ST APT 101
WHITEWATER WI
53190-2083
US

V. Phone/Fax

Practice location:
  • Phone: 262-472-0209
  • Fax: 262-472-0211
Mailing address:
  • Phone: 262-472-0209
  • Fax: 262-472-0211

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number3407-012
License Number StateWI

VIII. Authorized Official

Name: DR. PEGGY SUE LINNEMAN
Title or Position: OWNER
Credential: DC
Phone: 262-472-0209