Healthcare Provider Details

I. General information

NPI: 1003058710
Provider Name (Legal Business Name): JPM CHIROPRACTIC LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/26/2009
Last Update Date: 03/26/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9749 KAHL RD
BLACK EARTH WI
53515-9516
US

IV. Provider business mailing address

PO BOX 364
BLACK EARTH WI
53515-0364
US

V. Phone/Fax

Practice location:
  • Phone: 608-767-2226
  • Fax: 608-767-3226
Mailing address:
  • Phone: 608-767-2226
  • Fax: 608-767-3226

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number2509
License Number StateWI

VIII. Authorized Official

Name: DR. JOHN P MURPHY
Title or Position: CHIROPRACTOR OWNER
Credential: DC
Phone: 608-767-2226