BLAU CHIROPRACTIC SC NPI 1003003716

Chiropractor in Portage, WI

About BLAU CHIROPRACTIC SC

Blau Chiropractic Sc is a provider in Portage, WI. The NPI number assigned to this provider is 1003003716. The practitioner's primary taxonomy code is Chiropractor (111N00000X). The provider is registered as an organization and their NPI record was last updated 5 years ago. Blau Chiropractic Sc operates as a single speciality business group with one or more individual providers who practice the same area of specialization.

NPI1003003716 Additional informationCallout TooltipNational Provider Indentifier (NPI)
The 10-position all-numeric identification number assigned by the NPPES to uniquely identify a health care provider.
Provider NameBLAU CHIROPRACTIC SC
Provider Location Address641 LATTON LN PORTAGE, WI 53901 Additional informationCallout TooltipProvider location address
The location address of the provider being identified. For providers with more than one physical location, this is the primary location. This address cannot include a Post Office box.
Provider Mailing Address641 LATTON LN PORTAGE, WI 53901 Additional informationCallout TooltipProvider mailing address
The mailing address of the provider being identified. This address may contain the same information as the provider location address.
NPI Entity TypeOrganization Additional informationCallout TooltipEntity type code
The code describing the type of health care provider that is being assigned an NPI.
Codes are:
1 = (Person): individual human being who furnishes health care;
2 = (Non-person): entity other than an individual human being that furnishes health care (Examples: hospital, SNF, hospital subunit, pharmacy, or HMO).
Is Sole Proprietor?N/A
Is Organization Subpart?No Additional informationCallout TooltipWhat is a subpart?
Subparts are the components and separate physical locations of organization health care providers. Examples include:
Hospital components include outpatient departments, surgical centers, psychiatric units, and laboratories. These components are often separately licensed or certified by States and may exist at physical locations other than that of the hospital of which they are a component.
Enumeration Date09-26-2007 Additional informationCallout TooltipProvider enumeration date
The date the provider was assigned a unique identifier (assigned an NPI)
Last Update Date11-13-2012 Additional informationCallout TooltipLast update date
The date that a record was last updated or changed.

Business Address

BLAU CHIROPRACTIC SC
641 LATTON LN
PORTAGE, WI
ZIP 53901
Phone: (608) 742-1300
Fax: (608) 745-0147
Get Directions

Mailing Address

BLAU CHIROPRACTIC SC
641 LATTON LN
PORTAGE, WI
ZIP 53901
Phone: (608) 742-1300
Fax: (608) 745-0147

Primary Taxonomy

Taxonomy Code111N00000X Additional informationCallout TooltipPrimary Taxonomy Code
The primary taxonomy code defines the provider type, classification, and specialization. There could be only one primary taxonomy code per NPI record. For individual NPIs the license data is associated to the taxonomy code.
ClassificationChiropractor
TypeChiropractic Providers
License No.2990
License StateWI
Taxonomy DescriptionA provider qualified by a Doctor of Chiropractic (D.C.), licensed by the State and who practices chiropractic medicine -that discipline within the healing arts which deals with the nervous system and its relationship to the spinal column and its interrelationship with other body systems.

Authorized Official

Authorized Official NameDR. KEVIN A BLAU DC Additional informationCallout TooltipAuthorized official name
The name of the person authorized to submit the NPI application or to officially change data for a health care provider.
Authorized Official TitleCHIROPRACTOR
Authorized Official Phone(608) 742-1300

193400000X SINGLE SPECIALTY GROUP - This provdier is a business group of one or more individual practitioners, all of who practice with the same area of specialization.

Additional Identifiers


Additional identifier(s) currently or formerly used as an identifier for the provider. The codes may include UPIN, NSC, OSCAR, DEA, Medicaid State or PIN identification numbers.

Identifier Type / Code Identifier State
38887700MEDICAID (05)WI
000075332MEDICARE PIN (08)WI

Map Location


BLAU CHIROPRACTIC SC address is 641 LATTON LN PORTAGE, WI 53901

Other Providers at the same location


The following 3 providers are registered at the same or nearby location.

NPI Name / Type Taxonomy Address
1194237123 JESSICA ROSE DREDSKE DC
Individual
Chiropractor641 LATTON LN
PORTAGE, WI 53901
(608) 742-1300
1750610051DR. BRIAN DAVID HEEREN D.C.
Individual
Chiropractor641 LATTON LN
PORTAGE, WI 53901
(608) 742-1300
1932194172DR. KEVIN A. BLAU D.C.
Individual
Chiropractor641 LATTON LN SUITE A
PORTAGE, WI 53901
(608) 742-1300