1699046177 NPI number — SCHUELLER CHIROPRACTIC INC.

Table of content: DANIEL JOHN KEENAN MPT (NPI 1043915218)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1699046177 NPI number — SCHUELLER CHIROPRACTIC INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SCHUELLER CHIROPRACTIC INC.
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:
1699046177
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/16/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
808 5TH ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HUDSON
Provider Business Mailing Address State Name:
WI
Provider Business Mailing Address Postal Code:
54016-1613
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
715-386-7247
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
219 BROAD ST N
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PRESCOTT
Provider Business Practice Location Address State Name:
WI
Provider Business Practice Location Address Postal Code:
54021-1703
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
715-262-3661
Provider Business Practice Location Address Fax Number:
715-262-4146
Provider Enumeration Date:
01/16/2012

Additional Information

Authorized Official

Authorized Official Last Name:
SCHUELLER
Authorized Official First Name:
DONALD
Authorized Official Middle Name:
BURTON
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
715-386-7247

Provider Taxonomy Codes

  • Taxonomy code: 261Q00000X , with the licence number:  220012 , 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: 1528367521 , issued by the state of ( WI ) . This identifiers is of the category "MEDICAID".




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