Provider Demographics
NPI:1447459706
Name:PACKERLAND CHIROPRACTIC INC
Entity type:Organization
Organization Name:PACKERLAND CHIROPRACTIC INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:ANDREW
Authorized Official - Last Name:NELSON
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:920-496-8808
Mailing Address - Street 1:2615 PACKERLAND DR
Mailing Address - Street 2:SUITE G
Mailing Address - City:GREEN BAY
Mailing Address - State:WI
Mailing Address - Zip Code:54313-5780
Mailing Address - Country:US
Mailing Address - Phone:920-496-8808
Mailing Address - Fax:920-496-8808
Practice Address - Street 1:2615 PACKERLAND DR
Practice Address - Street 2:SUITE G
Practice Address - City:GREEN BAY
Practice Address - State:WI
Practice Address - Zip Code:54313-5780
Practice Address - Country:US
Practice Address - Phone:920-496-8808
Practice Address - Fax:920-496-8808
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-16
Last Update Date:2007-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI3486111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WIU-70394Medicare UPIN