Provider Demographics
NPI:1144719121
Name:TRINITY CHIROPRACTIC HEALTH CENTER LLC
Entity type:Organization
Organization Name:TRINITY CHIROPRACTIC HEALTH CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR OF CHIROPRACTIC
Authorized Official - Prefix:
Authorized Official - First Name:STORMIE
Authorized Official - Middle Name:
Authorized Official - Last Name:REIMAN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:715-459-7096
Mailing Address - Street 1:1830 WEBSTER ST STE 130
Mailing Address - Street 2:
Mailing Address - City:HUDSON
Mailing Address - State:WI
Mailing Address - Zip Code:54016-9321
Mailing Address - Country:US
Mailing Address - Phone:715-459-7096
Mailing Address - Fax:
Practice Address - Street 1:1830 WEBSTER ST STE 130
Practice Address - Street 2:
Practice Address - City:HUDSON
Practice Address - State:WI
Practice Address - Zip Code:54016-9321
Practice Address - Country:US
Practice Address - Phone:715-459-7096
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-05-06
Last Update Date:2018-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI5344-12111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN1538512686Medicaid