Provider Demographics
NPI:1730243890
Name:CHIROPRACTIC ASSOCIATES, S.C.
Entity type:Organization
Organization Name:CHIROPRACTIC ASSOCIATES, S.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER DOCTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:D
Authorized Official - Last Name:BLODGETT
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:414-476-6300
Mailing Address - Street 1:1467 S 108TH ST
Mailing Address - Street 2:
Mailing Address - City:WEST ALLIS
Mailing Address - State:WI
Mailing Address - Zip Code:53214-4018
Mailing Address - Country:US
Mailing Address - Phone:414-476-6300
Mailing Address - Fax:414-476-6319
Practice Address - Street 1:1467 S 108TH ST
Practice Address - Street 2:
Practice Address - City:WEST ALLIS
Practice Address - State:WI
Practice Address - Zip Code:53214-4018
Practice Address - Country:US
Practice Address - Phone:414-476-6300
Practice Address - Fax:414-476-6319
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-21
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV38995200Medicaid
WIU59602Medicare UPIN
WV38995200Medicaid
WIU58718Medicare UPIN