Healthcare Provider Details

I. General information

NPI: 1750441630
Provider Name (Legal Business Name): BACK & NECK WELLNESS CENTER INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/11/2006
Last Update Date: 12/21/2022
Certification Date: 12/21/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4222 MILWAUKEE ST 83
MADISON WI
53714-3508
US

IV. Provider business mailing address

4222 MILWAUKEE ST 83
MADISON WI
53714-3508
US

V. Phone/Fax

Practice location:
  • Phone: 608-222-4244
  • Fax: 608-222-9341
Mailing address:
  • Phone: 608-222-4244
  • Fax: 608-222-9341

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NS0005X
TaxonomySports Physician Chiropractor
License Number2250-012
License Number StateWI

VIII. Authorized Official

Name: MISS BONNIE JEAN LANGREHR
Title or Position: PRESIDENT
Credential: D.C.
Phone: 608-222-4244