Healthcare Provider Details

I. General information

NPI: 1831363431
Provider Name (Legal Business Name): HOWARD CHIROPRACTIC CLINIC, S.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/15/2008
Last Update Date: 12/21/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

721 CARDINAL LN STE 100
GREEN BAY WI
54313-3216
US

IV. Provider business mailing address

721 CARDINAL LN STE 100
GREEN BAY WI
54313-3216
US

V. Phone/Fax

Practice location:
  • Phone: 920-434-2221
  • Fax: 920-434-2483
Mailing address:
  • Phone: 920-434-2221
  • Fax: 920-434-2483

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code111NP0017X
TaxonomyPediatric Chiropractor
License Number3015
License Number StateWI
# 2
Primary TaxonomyN
Taxonomy Code111NR0400X
TaxonomyRehabilitation Chiropractor
License Number4133
License Number StateWI
# 3
Primary TaxonomyY
Taxonomy Code111NX0800X
TaxonomyOrthopedic Chiropractor
License Number2312
License Number StateWI

VIII. Authorized Official

Name: DENNIS KING
Title or Position: OWNER
Credential: DC
Phone: 920-434-2221