Provider Demographics
NPI:1174078133
Name:NASHOTAH CHIROPRACTIC CARE LLC
Entity type:Organization
Organization Name:NASHOTAH CHIROPRACTIC CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:LISA
Authorized Official - Middle Name:R
Authorized Official - Last Name:WEBER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:262-719-7878
Mailing Address - Street 1:309 MULBERRY DR
Mailing Address - Street 2:
Mailing Address - City:DELAFIELD
Mailing Address - State:WI
Mailing Address - Zip Code:53018-1070
Mailing Address - Country:US
Mailing Address - Phone:262-719-7878
Mailing Address - Fax:
Practice Address - Street 1:W330N4339 LAKELAND DR
Practice Address - Street 2:
Practice Address - City:NASHOTAH
Practice Address - State:WI
Practice Address - Zip Code:53058-9798
Practice Address - Country:US
Practice Address - Phone:262-719-7878
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-08-19
Last Update Date:2016-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2822261QH0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service