Provider Demographics
NPI:1770610990
Name:FAMILY CHIROCARE SC
Entity type:Organization
Organization Name:FAMILY CHIROCARE SC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:LANCE
Authorized Official - Middle Name:JASON
Authorized Official - Last Name:ALBRIGHTSON
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:715-265-7267
Mailing Address - Street 1:PO BOX 219
Mailing Address - Street 2:144 OAK STREET
Mailing Address - City:GLENWOOD CITY
Mailing Address - State:WI
Mailing Address - Zip Code:54013-0219
Mailing Address - Country:US
Mailing Address - Phone:715-265-7267
Mailing Address - Fax:715-265-7977
Practice Address - Street 1:144 OAK STREET
Practice Address - Street 2:
Practice Address - City:GLENWOOD CITY
Practice Address - State:WI
Practice Address - Zip Code:54013
Practice Address - Country:US
Practice Address - Phone:715-265-7267
Practice Address - Fax:715-265-7977
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-27
Last Update Date:2013-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI3886-012111N00000X
WI2311111N00000X
WI3566-012111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI391685971015OtherBCBS OF WI
WI38984400Medicaid
WI116M2FAOtherBCBS OF MN
WI391685971015OtherBCBS OF WI