Provider Demographics
NPI:1023177169
Name:OAS FAMILY CHIROPRACTIC, LLC
Entity type:Organization
Organization Name:OAS FAMILY CHIROPRACTIC, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:G
Authorized Official - Last Name:OAS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:715-552-7889
Mailing Address - Street 1:1740 WESTGATE RD
Mailing Address - Street 2:
Mailing Address - City:EAU CLAIRE
Mailing Address - State:WI
Mailing Address - Zip Code:54703-4963
Mailing Address - Country:US
Mailing Address - Phone:715-552-7889
Mailing Address - Fax:715-552-7939
Practice Address - Street 1:1740 WESTGATE RD
Practice Address - Street 2:
Practice Address - City:EAU CLAIRE
Practice Address - State:WI
Practice Address - Zip Code:54703-4963
Practice Address - Country:US
Practice Address - Phone:715-552-7889
Practice Address - Fax:715-552-7939
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-06
Last Update Date:2011-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI3823-012111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI39002100Medicaid
WI000035747Medicare ID - Type UnspecifiedMEDICARE ORGANIZATION NUM