Provider Demographics
NPI:1942591755
Name:ETERNAL SPRING NATURAL HEALTH CENTER
Entity Type:Organization
Organization Name:ETERNAL SPRING NATURAL HEALTH CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TODD
Authorized Official - Middle Name:
Authorized Official - Last Name:SHULFER
Authorized Official - Suffix:
Authorized Official - Credentials:DC,CAC
Authorized Official - Phone:920-486-1439
Mailing Address - Street 1:307 S COMMERCIAL ST
Mailing Address - Street 2:SUITE 203
Mailing Address - City:NEENAH
Mailing Address - State:WI
Mailing Address - Zip Code:54956-5700
Mailing Address - Country:US
Mailing Address - Phone:920-486-1439
Mailing Address - Fax:
Practice Address - Street 1:307 S COMMERCIAL ST
Practice Address - Street 2:SUITE 203
Practice Address - City:NEENAH
Practice Address - State:WI
Practice Address - Zip Code:54956-5700
Practice Address - Country:US
Practice Address - Phone:920-486-1439
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-04-27
Last Update Date:2011-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI3881-012111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty