Provider Demographics
NPI:1790965820
Name:SIGNATURE CHIROPRACTIC CENTER, LLC
Entity Type:Organization
Organization Name:SIGNATURE CHIROPRACTIC CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR/ OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:PROMISE
Authorized Official - Middle Name:ROSE
Authorized Official - Last Name:HONEYWELL
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:715-965-6398
Mailing Address - Street 1:1840 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:ONALASKA
Mailing Address - State:WI
Mailing Address - Zip Code:54650-7709
Mailing Address - Country:US
Mailing Address - Phone:608-785-7778
Mailing Address - Fax:608-785-1344
Practice Address - Street 1:1840 E MAIN ST
Practice Address - Street 2:
Practice Address - City:ONALASKA
Practice Address - State:WI
Practice Address - Zip Code:54650-7709
Practice Address - Country:US
Practice Address - Phone:608-785-7778
Practice Address - Fax:608-785-1344
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-06
Last Update Date:2007-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI4007012111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty