MEDICARE: CHIPPEWA FALLS CHIROPRACTIC, S.C.

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
1	111N00000X	Chiropractor	2431-012	WI

General Provider Information

NPI Number	:	1306970512
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CHIPPEWA FALLS CHIROPRACTIC, S.C.

Provider Business Mailing Address
First Line	:	4751 COUNTY HIGHWAY J
Second Line	:
City	:	CHIPPEWA FALLS
State	:	WI
Zip	:	54729
Country	:	US
Telephone Number	:	715-723-2713
Fax Number	:

Provider Business Practice Location Address
First Line	:	4751 COUNTY HIGHWAY J
Second Line	:
City	:	CHIPPEWA FALLS
State	:	WI
Zip	:	54729-3387
Country	:	US
Telephone Number	:	715-723-2713
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MICHAEL JOHN COURT
Credential	:	D.C.
Telephone Number	:	715-723-2713

Provider Enumeration Date	:	03/16/2007
Last Update Date	:	08/22/2020

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