Healthcare Provider Details

I. General information

NPI: 1891453353
Provider Name (Legal Business Name): TIARA LATZ DC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/02/2021
Last Update Date: 06/25/2026
Certification Date: 06/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

700 WOLSKE BAY RD STE 150
MENOMONIE WI
54751-1659
US

IV. Provider business mailing address

1207 TAINTER ST
MENOMONIE WI
54751-1570
US

V. Phone/Fax

Practice location:
  • Phone: 715-235-6767
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number6078
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: