Provider Demographics
NPI:1447304837
Name:CHIROPRACTIC CENTER OF ELKHORN LLC
Entity type:Organization
Organization Name:CHIROPRACTIC CENTER OF ELKHORN LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:
Authorized Official - Last Name:SCHENK
Authorized Official - Suffix:
Authorized Official - Credentials:DC DACRB
Authorized Official - Phone:262-723-2792
Mailing Address - Street 1:415 EAST GENEWA STREET
Mailing Address - Street 2:
Mailing Address - City:ELKHORN
Mailing Address - State:WI
Mailing Address - Zip Code:53121-1919
Mailing Address - Country:US
Mailing Address - Phone:262-723-2792
Mailing Address - Fax:262-723-2892
Practice Address - Street 1:415 EAST GENEWA STREET
Practice Address - Street 2:
Practice Address - City:ELKHORN
Practice Address - State:WI
Practice Address - Zip Code:53121-1919
Practice Address - Country:US
Practice Address - Phone:262-723-2792
Practice Address - Fax:262-723-2892
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-22
Last Update Date:2008-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI3201111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI000035134Medicare PIN