MEDICARE: DORN FAMILY CHIROPRACTIC 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	4053-012	WI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	396984426007	OTHER	WI	BCBS

General Provider Information

NPI Number	:	1922293711
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DORN FAMILY CHIROPRACTIC LLC

Provider Business Mailing Address
First Line	:	W359N5002 BROWN ST STE 220A
Second Line	:
City	:	OCONOMOWOC
State	:	WI
Zip	:	53066-3366
Country	:	US
Telephone Number	:	262-203-9036
Fax Number	:	262-203-9774

Provider Business Practice Location Address
First Line	:	W359N5002 BROWN ST STE 220A
Second Line	:
City	:	OCONOMOWOC
State	:	WI
Zip	:	53066-3366
Country	:	US
Telephone Number	:	262-203-9036
Fax Number	:	262-203-9774

Authorized Official
Title or Position	:	OWNER
Name	:	DR. ROBY C DORN
Credential	:	DC
Telephone Number	:	262-203-9036

Provider Enumeration Date	:	09/13/2007
Last Update Date	:	01/06/2026

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