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NPI Code Detail

MEDICARE: CHURCH CHIROPRACTIC CLINIC, LLC

MEDICARE: CHURCH CHIROPRACTIC CLINIC, LLC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1261QH0100XHealth Service Clinic/Center1444012WI

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1013175314
Entity Type Code : Organization
Provider Name (Legal Business Name) : CHURCH CHIROPRACTIC CLINIC, LLC
Provider Business Mailing Address
First Line : 1515 MOUNT ZION AVE
Second Line :
City : JANESVILLE
State : WI
Zip : 53545-1111
Country : US
Telephone Number : 608-754-6111
Fax Number :
Provider Business Practice Location Address
First Line : 1515 MOUNT ZION AVE
Second Line :
City : JANESVILLE
State : WI
Zip : 53545-1111
Country : US
Telephone Number : 608-754-6111
Fax Number :
Authorized Official
Title or Position : MANAGING MEMBER
Name : DR. JOHN E CHURCH
Credential :
Telephone Number : 608-754-6111
Provider Enumeration Date : 05/23/2008
Last Update Date : 05/23/2008

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