Healthcare Provider Details

I. General information

NPI: 1306010319
Provider Name (Legal Business Name): TRUE WELLNESS CHIROPRACTIC, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/22/2008
Last Update Date: 11/06/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

619A S. MAIN ST.
DEFOREST WI
53532-1421
US

IV. Provider business mailing address

619A S. MAIN ST.
DEFOREST WI
53532-1421
US

V. Phone/Fax

Practice location:
  • Phone: 608-842-2828
  • Fax: 608-842-2826
Mailing address:
  • Phone: 608-842-2828
  • Fax: 608-842-2826

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number4361-12
License Number StateWI

VIII. Authorized Official

Name: JAMEY R KING
Title or Position: OWNER
Credential: DC
Phone: 608-842-2828