Provider Demographics
NPI:1053615138
Name:WESTOSHA FAMILY CHIROPRACTIC LLC
Entity type:Organization
Organization Name:WESTOSHA FAMILY CHIROPRACTIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:TOBY
Authorized Official - Middle Name:
Authorized Official - Last Name:HAWKES
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:262-843-1939
Mailing Address - Street 1:24706 75TH ST
Mailing Address - Street 2:SUITE 200
Mailing Address - City:SALEM
Mailing Address - State:WI
Mailing Address - Zip Code:53168-9704
Mailing Address - Country:US
Mailing Address - Phone:262-843-1939
Mailing Address - Fax:
Practice Address - Street 1:24706 75TH ST
Practice Address - Street 2:SUITE 200
Practice Address - City:SALEM
Practice Address - State:WI
Practice Address - Zip Code:53168-9704
Practice Address - Country:US
Practice Address - Phone:262-843-1939
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-01-04
Last Update Date:2011-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NN1001XChiropractic ProvidersChiropractorNutritionGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI35242Medicare UPIN