1912330754 NPI number — VIKE-STEINICH FAMILY CHIROPRACTIC, LLC

Table of content: (NPI 1912330754)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1912330754 NPI number — VIKE-STEINICH FAMILY CHIROPRACTIC, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
VIKE-STEINICH FAMILY CHIROPRACTIC, LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1912330754
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/20/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
320 W MAIN ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MOUNT HOREB
Provider Business Mailing Address State Name:
WI
Provider Business Mailing Address Postal Code:
53572-1917
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
608-437-2222
Provider Business Mailing Address Fax Number:
608-437-7463

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
320 W MAIN ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MOUNT HOREB
Provider Business Practice Location Address State Name:
WI
Provider Business Practice Location Address Postal Code:
53572-1917
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
608-437-2222
Provider Business Practice Location Address Fax Number:
608-437-7463
Provider Enumeration Date:
08/15/2013

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
VIKE-STEINICH
Authorized Official First Name:
KRISTIN
Authorized Official Middle Name:
MARIE
Authorized Official Title or Position:
OWNER/DOCTOR OF CHIROPRACTIC
Authorized Official Telephone Number:
608-437-2222

Provider Taxonomy Codes

  • Taxonomy code: 111N00000X , with the licence number:  4258-12 , registered in the state of WI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 38974800 , issued by the state of ( WI ) . This identifiers is of the category "MEDICAID".