1679618193 NPI number — OLIEN FAMILY CHIROPRACTIC LLC

Table of content: (NPI 1679618193)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1679618193 NPI number — OLIEN FAMILY CHIROPRACTIC LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
OLIEN 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:
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:
1679618193
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/10/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
706 W 4TH ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NEW RICHMOND
Provider Business Mailing Address State Name:
WI
Provider Business Mailing Address Postal Code:
54017-1440
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
715-246-2390
Provider Business Mailing Address Fax Number:
715-246-7830

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
706 W 4TH ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NEW RICHMOND
Provider Business Practice Location Address State Name:
WI
Provider Business Practice Location Address Postal Code:
54017-1440
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
715-246-2390
Provider Business Practice Location Address Fax Number:
715-246-7830
Provider Enumeration Date:
02/21/2007

Additional Information

Authorized Official

Authorized Official Last Name:
OLIEN
Authorized Official First Name:
DANIEL
Authorized Official Middle Name:
R
Authorized Official Title or Position:
OWNER CHIROPRACTOR
Authorized Official Telephone Number:
715-246-2390

Provider Taxonomy Codes

  • Taxonomy code: 111N00000X , with the licence number:  3943-012 , 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: 1477648210 . This is a "INDIVIDUAL NPI NUMBER" identifier , issued by the state of ( WI ) . This identifiers is of the category "OTHER".




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