Provider Demographics
NPI:1366759979
Name:WHITEWATER CHIROPRACTIC, LLC
Entity type:Organization
Organization Name:WHITEWATER CHIROPRACTIC, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:PEGGY
Authorized Official - Middle Name:SUE
Authorized Official - Last Name:LINNEMAN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:262-472-0209
Mailing Address - Street 1:214 S 2ND ST APT 101
Mailing Address - Street 2:
Mailing Address - City:WHITEWATER
Mailing Address - State:WI
Mailing Address - Zip Code:53190-2083
Mailing Address - Country:US
Mailing Address - Phone:262-472-0209
Mailing Address - Fax:262-472-0211
Practice Address - Street 1:214 S 2ND ST APT 101
Practice Address - Street 2:
Practice Address - City:WHITEWATER
Practice Address - State:WI
Practice Address - Zip Code:53190-2083
Practice Address - Country:US
Practice Address - Phone:262-472-0209
Practice Address - Fax:262-472-0211
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-09-02
Last Update Date:2010-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI3407-012111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI38900000Medicaid
WI38900000Medicaid