Provider Demographics
NPI:1538220454
Name:NATURAL HEALTH CHIROPRACTIC, L.L.C.
Entity type:Organization
Organization Name:NATURAL HEALTH CHIROPRACTIC, L.L.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:PAULA
Authorized Official - Middle Name:L
Authorized Official - Last Name:BENBOW
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:920-494-8008
Mailing Address - Street 1:110 PACKERLAND DR
Mailing Address - Street 2:SUITE B
Mailing Address - City:GREEN BAY
Mailing Address - State:WI
Mailing Address - Zip Code:54303-4861
Mailing Address - Country:US
Mailing Address - Phone:920-494-8008
Mailing Address - Fax:920-494-1844
Practice Address - Street 1:110 PACKERLAND DR
Practice Address - Street 2:SUITE B
Practice Address - City:GREEN BAY
Practice Address - State:WI
Practice Address - Zip Code:54303-4861
Practice Address - Country:US
Practice Address - Phone:920-494-8008
Practice Address - Fax:920-494-1844
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-13
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2625-012111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI38851700Medicaid
WI=========011OtherBLUE CROSS CLINIC
WI38851700Medicaid