Provider Demographics
NPI:1750441630
Name:BACK & NECK WELLNESS CENTER INC.
Entity type:Organization
Organization Name:BACK & NECK WELLNESS CENTER INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MISS
Authorized Official - First Name:BONNIE
Authorized Official - Middle Name:JEAN
Authorized Official - Last Name:LANGREHR
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:608-222-4244
Mailing Address - Street 1:4222 MILWAUKEE ST
Mailing Address - Street 2:83
Mailing Address - City:MADISON
Mailing Address - State:WI
Mailing Address - Zip Code:53714-3508
Mailing Address - Country:US
Mailing Address - Phone:608-222-4244
Mailing Address - Fax:608-222-9341
Practice Address - Street 1:4222 MILWAUKEE ST
Practice Address - Street 2:83
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53714-3508
Practice Address - Country:US
Practice Address - Phone:608-222-4244
Practice Address - Fax:608-222-9341
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-11
Last Update Date:2022-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2250-012111NS0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NS0005XChiropractic ProvidersChiropractorSports PhysicianGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI1699741801OtherNPI NUMBER
WI000135661Medicare ID - Type Unspecified