Provider Demographics
NPI:1861108763
Name:KLUEGERCHIROPRACTIC LLC
Entity type:Organization
Organization Name:KLUEGERCHIROPRACTIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:INSURANCE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:MELISSA
Authorized Official - Middle Name:J
Authorized Official - Last Name:DITTBRENDER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:920-467-8690
Mailing Address - Street 1:275 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:SHEBOYGAN FALLS
Mailing Address - State:WI
Mailing Address - Zip Code:53085-3315
Mailing Address - Country:US
Mailing Address - Phone:920-467-8690
Mailing Address - Fax:920-467-0373
Practice Address - Street 1:275 N MAIN STREET
Practice Address - Street 2:
Practice Address - City:SHEBOYGAN FALLS
Practice Address - State:WI
Practice Address - Zip Code:53085-3315
Practice Address - Country:US
Practice Address - Phone:920-467-8690
Practice Address - Fax:920-467-0373
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-01-25
Last Update Date:2023-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI1447977798Medicaid