Provider Demographics
NPI:1326441841
Name:CHIPPEWA VALLEY NEUROMONITORING, LLC
Entity Type:Organization
Organization Name:CHIPPEWA VALLEY NEUROMONITORING, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:JON
Authorized Official - Middle Name:P
Authorized Official - Last Name:KONZEN
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:715-831-0811
Mailing Address - Street 1:950 W CLAIREMONT AVE
Mailing Address - Street 2:
Mailing Address - City:EAU CLAIRE
Mailing Address - State:WI
Mailing Address - Zip Code:54701-6192
Mailing Address - Country:US
Mailing Address - Phone:715-831-0811
Mailing Address - Fax:715-831-0802
Practice Address - Street 1:950 W CLAIREMONT AVE
Practice Address - Street 2:
Practice Address - City:EAU CLAIRE
Practice Address - State:WI
Practice Address - Zip Code:54701-6192
Practice Address - Country:US
Practice Address - Phone:715-831-0811
Practice Address - Fax:715-831-0802
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-09-29
Last Update Date:2014-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI371380212084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Multi-Specialty