Healthcare Provider Details

I. General information

NPI: 1407035686
Provider Name (Legal Business Name): EAU CLAIRE CHIROPRACTIC, SC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/24/2007
Last Update Date: 11/07/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4606 COMMERCE VALLEY RD SUITE 209
EAU CLAIRE WI
54701-7074
US

IV. Provider business mailing address

4606 COMMERCE VALLEY RD SUITE 209
EAU CLAIRE WI
54701-7074
US

V. Phone/Fax

Practice location:
  • Phone: 715-832-6616
  • Fax: 715-832-6454
Mailing address:
  • Phone: 715-832-6616
  • Fax: 715-832-6454

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number1754
License Number StateWI

VIII. Authorized Official

Name: DR. CHRIS HENRY HOUGEN
Title or Position: PRESIDENT
Credential: D.C.
Phone: 715-832-6616