Provider Demographics
NPI:1821417882
Name:WISCONSIN CHIROPRACTIC & WELLNESS CENTER LLC
Entity Type:Organization
Organization Name:WISCONSIN CHIROPRACTIC & WELLNESS CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:HOANVU
Authorized Official - Middle Name:QUANG
Authorized Official - Last Name:NGUYEN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:920-486-4031
Mailing Address - Street 1:163 E NORTH WATER ST
Mailing Address - Street 2:
Mailing Address - City:NEENAH
Mailing Address - State:WI
Mailing Address - Zip Code:54956-2708
Mailing Address - Country:US
Mailing Address - Phone:920-486-4031
Mailing Address - Fax:920-725-2909
Practice Address - Street 1:163 E NORTH WATER ST
Practice Address - Street 2:
Practice Address - City:NEENAH
Practice Address - State:WI
Practice Address - Zip Code:54956-2708
Practice Address - Country:US
Practice Address - Phone:920-486-4031
Practice Address - Fax:920-725-2909
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-04-07
Last Update Date:2014-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI3534-12111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty