1437102563 NPI number — BURKHALTER CHIROPRACTIC SC

Table of content: (NPI 1437102563)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1437102563 NPI number — BURKHALTER CHIROPRACTIC SC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
BURKHALTER CHIROPRACTIC SC
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:
6
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:
1437102563
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/07/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
920 8TH AVENUE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BARABOO
Provider Business Mailing Address State Name:
WI
Provider Business Mailing Address Postal Code:
53913
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
608-356-3811
Provider Business Mailing Address Fax Number:
608-356-8011

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
920 8TH AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BARABOO
Provider Business Practice Location Address State Name:
WI
Provider Business Practice Location Address Postal Code:
53913-1247
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
608-356-3811
Provider Business Practice Location Address Fax Number:
608-356-8011
Provider Enumeration Date:
05/18/2006

Additional Information

Authorized Official

Authorized Official Last Name:
ARSENAULT-BURKHALTER
Authorized Official First Name:
MELANIE
Authorized Official Middle Name:
A
Authorized Official Title or Position:
DOCTOR OWNER
Authorized Official Telephone Number:
608-356-3811

Provider Taxonomy Codes

  • Taxonomy code: 111N00000X , with the licence number:  3359 , registered in the state of WI ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 111N00000X , with the licence number: 3443 , 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: 38896000 , issued by the state of ( WI ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2025 www.npivalidator.com