Healthcare Provider Details

I. General information

NPI: 1497937122
Provider Name (Legal Business Name): FAMILY CHIROPRACTIC CLINIC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/05/2007
Last Update Date: 01/08/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1215 BLACK BRIDGE RD
JANESVILLE WI
53545-0891
US

IV. Provider business mailing address

1215 BLACK BRIDGE RD
JANESVILLE WI
53545-0891
US

V. Phone/Fax

Practice location:
  • Phone: 608-754-4216
  • Fax: 608-754-2742
Mailing address:
  • Phone: 608-754-4216
  • Fax: 608-754-2742

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NR0400X
TaxonomyRehabilitation Chiropractor
License Number2516-012
License Number StateWI

VIII. Authorized Official

Name: DR. JOHN GRANT SCHOENENBERGER
Title or Position: CHIROPRACTOR
Credential: D.C.
Phone: 608-754-4216