Provider Demographics
NPI:1760725329
Name:BODY WAVE CORPORATION
Entity Type:Organization
Organization Name:BODY WAVE CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LAURA
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:KONOPACKI
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:608-556-1705
Mailing Address - Street 1:2984 TRIVERTON PIKE DR
Mailing Address - Street 2:STE. 102
Mailing Address - City:FITCHBURG
Mailing Address - State:WI
Mailing Address - Zip Code:53711-5841
Mailing Address - Country:US
Mailing Address - Phone:608-556-1705
Mailing Address - Fax:
Practice Address - Street 1:2984 TRIVERTON PIKE DR
Practice Address - Street 2:STE. 102
Practice Address - City:FITCHBURG
Practice Address - State:WI
Practice Address - Zip Code:53711-5841
Practice Address - Country:US
Practice Address - Phone:608-556-1705
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-04-02
Last Update Date:2015-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI391512111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WIWI3123Medicare PIN