Provider Demographics
NPI:1366189565
Name:SHALOM FAMILY CHIROPRACTIC, LLC
Entity type:Organization
Organization Name:SHALOM FAMILY CHIROPRACTIC, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:SHALOM
Authorized Official - Middle Name:
Authorized Official - Last Name:SAMUEL
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:608-886-8568
Mailing Address - Street 1:1059 PROVIDENCE CMN
Mailing Address - Street 2:
Mailing Address - City:SUN PRAIRIE
Mailing Address - State:WI
Mailing Address - Zip Code:53590-4586
Mailing Address - Country:US
Mailing Address - Phone:608-886-8568
Mailing Address - Fax:
Practice Address - Street 1:2810 CROSSROADS DR STE 4000
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53718-8014
Practice Address - Country:US
Practice Address - Phone:608-886-8568
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-05-18
Last Update Date:2022-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty