Healthcare Provider Details

I. General information

NPI: 1588823884
Provider Name (Legal Business Name): CHIRTOPRACTIC HEALTH CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/03/2008
Last Update Date: 08/31/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1208 9TH STREET
BARABOO WI
53913
US

IV. Provider business mailing address

1208 9TH STREET
BARABOO WI
53913
US

V. Phone/Fax

Practice location:
  • Phone: 608-356-0177
  • Fax: 608-356-3265
Mailing address:
  • Phone: 608-356-0177
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NI0013X
TaxonomyIndependent Medical Examiner Chiropractor
License Number2665-012
License Number StateWI

VIII. Authorized Official

Name: MS. PAMELA J THOMPSON
Title or Position: DOCTOR/OWNER
Credential: D.C.
Phone: 608-356-0177