Provider Demographics
NPI:1881141737
Name:IMPERIUM CHIROPRACTIC
Entity type:Organization
Organization Name:IMPERIUM CHIROPRACTIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINIC DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:ROBYN
Authorized Official - Middle Name:
Authorized Official - Last Name:TOZER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:715-532-6394
Mailing Address - Street 1:W8646 US HIGHWAY 8
Mailing Address - Street 2:
Mailing Address - City:LADYSMITH
Mailing Address - State:WI
Mailing Address - Zip Code:54848-9501
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3301 GOLF RD
Practice Address - Street 2:SUITE 102
Practice Address - City:EAU CLAIRE
Practice Address - State:WI
Practice Address - Zip Code:54701-4682
Practice Address - Country:US
Practice Address - Phone:715-514-4302
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:IMPERIUM CHIROPRACTIC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2016-09-08
Last Update Date:2021-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI3324-12111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI38890800Medicaid
K100194764Medicare PIN