MEDICARE: MILWAUKEE CHIROPRACTIC AND REHAB, 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
1	111N00000X	Chiropractor	4600-012	WI

General Provider Information

NPI Number	:	1376045534
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MILWAUKEE CHIROPRACTIC AND REHAB, LLC

Provider Business Mailing Address
First Line	:	4111 N PORT WASHINGTON RD
Second Line	:
City	:	MILWAUKEE
State	:	WI
Zip	:	53212-1029
Country	:	US
Telephone Number	:	414-395-1279
Fax Number	:

Provider Business Practice Location Address
First Line	:	4111 N PORT WASHINGTON RD
Second Line	:
City	:	MILWAUKEE
State	:	WI
Zip	:	53212-1029
Country	:	US
Telephone Number	:	414-395-1279
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	DR. CHAD SLODEN
Credential	:	DC
Telephone Number	:	414-395-1279

Provider Enumeration Date	:	03/05/2018
Last Update Date	:	03/05/2018

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