Provider Demographics
NPI:1700046117
Name:SCOLIOSIS CENTER OF WISCONSIN
Entity Type:Organization
Organization Name:SCOLIOSIS CENTER OF WISCONSIN
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINIC DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:JOHN
Authorized Official - Last Name:SCHWAB
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:715-838-0827
Mailing Address - Street 1:1030 OAK RIDGE DR
Mailing Address - Street 2:SUITE D
Mailing Address - City:EAU CLAIRE
Mailing Address - State:WI
Mailing Address - Zip Code:54701-4564
Mailing Address - Country:US
Mailing Address - Phone:715-838-0827
Mailing Address - Fax:715-838-0400
Practice Address - Street 1:1030 OAK RIDGE DR
Practice Address - Street 2:SUITE D
Practice Address - City:EAU CLAIRE
Practice Address - State:WI
Practice Address - Zip Code:54701-4564
Practice Address - Country:US
Practice Address - Phone:715-838-0827
Practice Address - Fax:715-838-0400
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-10
Last Update Date:2008-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI4037-012261QH0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service