Provider Demographics
NPI:1780934638
Name:WISCONSIN INTEGRATIVE HYPERBARIC CENTER
Entity type:Organization
Organization Name:WISCONSIN INTEGRATIVE HYPERBARIC CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:SHANNON
Authorized Official - Middle Name:M
Authorized Official - Last Name:KENITZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:608-278-4268
Mailing Address - Street 1:6200 NESBITT RD STE B
Mailing Address - Street 2:
Mailing Address - City:FITCHBURG
Mailing Address - State:WI
Mailing Address - Zip Code:53719-1949
Mailing Address - Country:US
Mailing Address - Phone:608-278-4268
Mailing Address - Fax:608-278-4260
Practice Address - Street 1:6200 NESBITT RD STE B
Practice Address - Street 2:
Practice Address - City:FITCHBURG
Practice Address - State:WI
Practice Address - Zip Code:53719-1949
Practice Address - Country:US
Practice Address - Phone:608-278-4268
Practice Address - Fax:608-278-4260
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-09-18
Last Update Date:2012-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty