Healthcare Provider Details

I. General information

NPI: 1033511688
Provider Name (Legal Business Name): VAN ROO FAMILY CHIROPRACTIC LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/25/2014
Last Update Date: 09/25/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2505 MILTON AVE
JANESVILLE WI
53545-0441
US

IV. Provider business mailing address

2505 MILTON AVE
JANESVILLE WI
53545-0441
US

V. Phone/Fax

Practice location:
  • Phone: 608-756-5225
  • Fax: 608-756-0506
Mailing address:
  • Phone: 608-756-5225
  • Fax: 608-756-0506

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number
License Number State

VIII. Authorized Official

Name: DR. RYAN T VAN ROO
Title or Position: PRESIDENT
Credential: DC
Phone: 608-756-5225