Provider Demographics
NPI:1316047608
Name:MONICA E. MARONEY S C
Entity type:Organization
Organization Name:MONICA E. MARONEY S C
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MONICA
Authorized Official - Middle Name:E
Authorized Official - Last Name:MARONEY
Authorized Official - Suffix:
Authorized Official - Credentials:DC, DICCP
Authorized Official - Phone:414-962-5483
Mailing Address - Street 1:4433 N OAKLAND AVE
Mailing Address - Street 2:SUITE A
Mailing Address - City:SHOREWOOD
Mailing Address - State:WI
Mailing Address - Zip Code:53211-1600
Mailing Address - Country:US
Mailing Address - Phone:414-962-5483
Mailing Address - Fax:414-962-5482
Practice Address - Street 1:4433 N OAKLAND AVE
Practice Address - Street 2:SUITE A
Practice Address - City:SHOREWOOD
Practice Address - State:WI
Practice Address - Zip Code:53211-1600
Practice Address - Country:US
Practice Address - Phone:414-962-5483
Practice Address - Fax:414-962-5482
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-25
Last Update Date:2011-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI3821-012111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI38940700Medicaid
WI000035444Medicare UPIN
WI38940700Medicaid