Coleman Chiropractic Center, LLC
Organization Active NPI Chiropractor · Coleman, WI
NPI 1962578658 · NPPES record last updated Aug 22, 2020
Key facts
- NPI
- 1962578658
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Chiropractor 111N00000X
- License
- 3681-012 (WI)
- Legal business name
- COLEMAN CHIROPRACTIC CENTER, LLC
- Practice address
- 205 N Park Ave
Coleman, WI 54112-9438 - Phone
- (920) 897-4566
- NPI assigned
- Nov 27, 2006
- Organization subpart
- No
Authorized official
- Name
- Dr. Jason Graetz
- Title
- Manager
- Phone
- (920) 897-4566
Practitioners 1
-
Jason Graetz, D.C.
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in WI
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20041220000529 | WI | Part B Supplier - Clinic/Group Practice | 6901863174 |
Receives reassigned benefits from 1 practitioner Practice locations: Coleman, WI |
National Provider Directory
Locations
205 N Park Ave
Coleman, WI 54112
Phone (920) 897-4566
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Chiropractor |
111N00000X | 3681-012 | WI | Yes |
Addresses
Primary practice location
205 N Park Ave
Coleman, WI 54112-9438
Mailing address
205 N Park Ave
Coleman, WI 54112-9438
Phone (920) 897-4566
Other providers in Coleman, WI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Aug 22, 2020. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.