=====================================================
General NPI Number Information
=====================================================
NPI Number | 1295012219
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | RIVER CITY CHIROPRACTIC S.C.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/04/2011
-----------------------------------------------------
Last Update Date | 02/05/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 205 GREEN ST STE 102
-----------------------------------------------------
City | ONALASKA
-----------------------------------------------------
State | WI
-----------------------------------------------------
Zip | 54650-3329
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 612-799-6442
-----------------------------------------------------
Fax | 855-545-8127
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 205 GREEN ST STE 102
-----------------------------------------------------
City | ONALASKA
-----------------------------------------------------
State | WI
-----------------------------------------------------
Zip | 54650-3330
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 608-408-2488
-----------------------------------------------------
Fax | 855-545-8127
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | COREY STEPHEN HARRIS
-----------------------------------------------------
Credential | D.C.
-----------------------------------------------------
Telephone | 608-408-2488
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 111N00000X
-----------------------------------------------------
Taxonomy Name | Chiropractor
-----------------------------------------------------
License Number | 5034
-----------------------------------------------------
License Number State | WI
-----------------------------------------------------