Basic Information
| Provider Information | |||||||||
| NPI: | 1235577008 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SAMUEL | ||||||||
| FirstName: | STEVEN | ||||||||
| MiddleName: | D | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | D.C. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1640 E SUMNER ST | ||||||||
| Address2: | |||||||||
| City: | HARTFORD | ||||||||
| State: | WI | ||||||||
| PostalCode: | 530272684 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2626704000 | ||||||||
| FaxNumber: | 2626704451 | ||||||||
| Practice Location | |||||||||
| Address1: | 1640 E SUMNER ST | ||||||||
| Address2: | |||||||||
| City: | HARTFORD | ||||||||
| State: | WI | ||||||||
| PostalCode: | 530272684 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2626704000 | ||||||||
| FaxNumber: | 2626704451 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/13/2013 | ||||||||
| LastUpdateDate: | 11/18/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 11/18/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 111N00000X | 4926-12 | WI | Y | Chiropractic Providers | Chiropractor |
No ID Information.