| Prohealth Chiropractic Center S.c. | |
|
321 Carroll St Random Lake WI 53075-1813 | |
| (920) 994-2000 | |
| Not Available |
| Full Name | Prohealth Chiropractic Center S.c. |
|---|---|
| Speciality | Clinic/Center |
| Location | 321 Carroll St, Random Lake, Wisconsin |
| Authorized Official Name and Position | Eric Stanenas (OWNER) |
| Authorized Official Contact | 4146179470 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Prohealth Chiropractic Center S.c. 321 Carroll St Random Lake WI 53075-1813 Ph: () - | Prohealth Chiropractic Center S.c. 321 Carroll St Random Lake WI 53075-1813 Ph: (920) 994-2000 |
| NPI Number | 1699064022 |
|---|---|
| Provider Enumeration Date | 04/06/2011 |
| Last Update Date | 05/03/2011 |
| Medicare PECOS PAC ID | 9537346655 |
|---|---|
| Medicare Enrollment ID | O20110526000637 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1699064022 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261Q00000X | Clinic/center | (* (Not Available)) | Primary |
| Provider Name | Maria P Fenske |
|---|---|
| Provider Type | Practitioner - Chiropractic |
| Provider Identifiers | NPI Number: 1356324032 PECOS PAC ID: 1759416381 Enrollment ID: I20100320000235 |
| Provider Name | Eric Mathew Stanenas |
|---|---|
| Provider Type | Practitioner - Chiropractic |
| Provider Identifiers | NPI Number: 1457655847 PECOS PAC ID: 0446437560 Enrollment ID: I20110526000658 |
Random Lake Medical Center Llc Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: N639 Silver Creek Cascade Road, Random Lake, WI 53075 Phone: 920-994-9999 Fax: 920-994-9998 | |
Random Lake Spine & Sports Clinic Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 321 Carroll St., Random Lake, WI 53075 Phone: 920-994-2000 |