Provider Demographics
NPI:1548486665
Name:WELTY CHIROPRACTIC, S.C.
Entity type:Organization
Organization Name:WELTY CHIROPRACTIC, S.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING REPRESENTATIVE
Authorized Official - Prefix:MRS
Authorized Official - First Name:BRANDIE
Authorized Official - Middle Name:M
Authorized Official - Last Name:STIPAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:414-529-4180
Mailing Address - Street 1:PO BOX 270345
Mailing Address - Street 2:
Mailing Address - City:WEST ALLIS
Mailing Address - State:WI
Mailing Address - Zip Code:53227-0345
Mailing Address - Country:US
Mailing Address - Phone:414-529-4180
Mailing Address - Fax:414-858-9082
Practice Address - Street 1:125 E ADAMS ST
Practice Address - Street 2:
Practice Address - City:CLAY CITY
Practice Address - State:IL
Practice Address - Zip Code:62824
Practice Address - Country:US
Practice Address - Phone:618-676-1532
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-17
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL=========OtherEIN
IL210318Medicare ID - Type UnspecifiedIL MEDICARE GROUP #