Provider Demographics
NPI:1528138062
Name:CRANDON CHIROPRACTIC S.C.
Entity type:Organization
Organization Name:CRANDON CHIROPRACTIC S.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:WANDA
Authorized Official - Middle Name:JEAN
Authorized Official - Last Name:ERDMAN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:715-478-3651
Mailing Address - Street 1:409 N LAKE AVE
Mailing Address - Street 2:
Mailing Address - City:CRANDON
Mailing Address - State:WI
Mailing Address - Zip Code:54520-1285
Mailing Address - Country:US
Mailing Address - Phone:715-478-3651
Mailing Address - Fax:715-478-3665
Practice Address - Street 1:409 N LAKE AVE
Practice Address - Street 2:
Practice Address - City:CRANDON
Practice Address - State:WI
Practice Address - Zip Code:54520-1285
Practice Address - Country:US
Practice Address - Phone:715-478-3651
Practice Address - Fax:715-478-3665
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-09
Last Update Date:2007-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty