Provider Demographics
NPI:1780986703
Name:DUMOND CHIROPRACTIC, S.C.
Entity type:Organization
Organization Name:DUMOND CHIROPRACTIC, S.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:
Authorized Official - Last Name:DUMOND
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:608-647-2119
Mailing Address - Street 1:165 N. CENTRAL AVE.
Mailing Address - Street 2:SUITE 101
Mailing Address - City:RICHLAND CENTER
Mailing Address - State:WI
Mailing Address - Zip Code:53581-0189
Mailing Address - Country:US
Mailing Address - Phone:608-647-2119
Mailing Address - Fax:608-647-7539
Practice Address - Street 1:165 N. CENTRAL AVE.
Practice Address - Street 2:SUITE 101
Practice Address - City:RICHLAND CENTER
Practice Address - State:WI
Practice Address - Zip Code:53581-0189
Practice Address - Country:US
Practice Address - Phone:608-647-2119
Practice Address - Fax:608-647-7539
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-11-23
Last Update Date:2010-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1377261QH0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI38830700Medicaid
WI38830700Medicaid
WI000075495Medicare PIN