Healthcare Provider Details

I. General information

NPI: 1225312366
Provider Name (Legal Business Name): COMMUNITY CHIROPRACTIC S.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/07/2011
Last Update Date: 10/07/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1957 COUNTY ROAD XX
KRONENWETTER WI
54455-9026
US

IV. Provider business mailing address

1957 COUNTY ROAD XX
KRONENWETTER WI
54455-9026
US

V. Phone/Fax

Practice location:
  • Phone: 715-359-9924
  • Fax: 715-355-9109
Mailing address:
  • Phone: 715-359-9924
  • Fax: 715-355-9109

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: DR. COREY POMRANKE
Title or Position: OWNER/PRESIDEN
Credential: D.C.
Phone: 715-359-9924