Healthcare Provider Details

I. General information

NPI: 1700046117
Provider Name (Legal Business Name): SCOLIOSIS CENTER OF WISCONSIN
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/10/2008
Last Update Date: 06/10/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1030 OAK RIDGE DR SUITE D
EAU CLAIRE WI
54701-4564
US

IV. Provider business mailing address

1030 OAK RIDGE DR SUITE D
EAU CLAIRE WI
54701-4564
US

V. Phone/Fax

Practice location:
  • Phone: 715-838-0827
  • Fax: 715-838-0400
Mailing address:
  • Phone: 715-838-0827
  • Fax: 715-838-0400

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QH0100X
TaxonomyHealth Service Clinic/Center
License Number4037-012
License Number StateWI

VIII. Authorized Official

Name: DR. MATTHEW JOHN SCHWAB
Title or Position: CLINIC DIRECTOR
Credential: DC
Phone: 715-838-0827