Theobald, Jason C

Theobald, Jason C is an individual health care provider with primary practice located at 550 W Maple St , Baraboo WI 53913-1166. He recently has only one registered license in Chiropractic Providers / Chiropractor, which is considered as his primary health care specialty. Theobald, Jason C can be contacted via phone (608) 355-4100.

Contact Information

Primary practice address
550 W Maple St Baraboo WI 53913-1166
Phone: (608) 355-4100
Fax: (608) 355-4107
Website:
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Health care specialties

SpecialtyCodeLicense #State
Chiropractic Providers / Chiropractor 111N00000X 3855-012 Wisconsin

Profile Details

NPI number 1962509604
LBN Legal business name Theobald, Jason C
Credentials Doctor of Chiropractic (DC)
Entity Individual
Sole proprietor 1 No
Enumeration date Sep 17th, 2006
Last updated Jan 20th, 2016 - about 10 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1962509604 NPPES
Wisconsin Other 38996600 MEDICAID GROUP
Wisconsin Other CB3715 MEDICAID GROUP
Wisconsin MEDICAID 38939100 MEDICAID GROUP
Wisconsin Other 350056012 MEDICAID GROUP

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