Provider Demographics
NPI:1861625832
Name:NOLTE CHIROPRACTIC LLC
Entity type:Organization
Organization Name:NOLTE CHIROPRACTIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:JEFFERY
Authorized Official - Middle Name:DEAN
Authorized Official - Last Name:NOLTE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:608-741-0222
Mailing Address - Street 1:942 N PARKER DR
Mailing Address - Street 2:
Mailing Address - City:JANESVILLE
Mailing Address - State:WI
Mailing Address - Zip Code:53545-0710
Mailing Address - Country:US
Mailing Address - Phone:608-741-0222
Mailing Address - Fax:
Practice Address - Street 1:942 N PARKER DR
Practice Address - Street 2:
Practice Address - City:JANESVILLE
Practice Address - State:WI
Practice Address - Zip Code:53545-0710
Practice Address - Country:US
Practice Address - Phone:608-741-0222
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-08-25
Last Update Date:2012-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2596111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI38849300Medicaid
WI38849300Medicaid