Healthcare Provider Details

I. General information

NPI: 1205347564
Provider Name (Legal Business Name): MOTUS CHIROPRACTIC & SPINE REHAB SC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/13/2017
Last Update Date: 06/20/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5261 N PORTWASHINGTON RD
MILWAUKEE WI
53217-5321
US

IV. Provider business mailing address

PO BOX 170181
MILWAUKEE WI
53217-8016
US

V. Phone/Fax

Practice location:
  • Phone: 414-967-9000
  • Fax: 414-332-3712
Mailing address:
  • Phone: 414-967-9000
  • Fax: 414-332-3712

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NR0400X
TaxonomyRehabilitation Chiropractor
License Number3825-012
License Number StateWI

VIII. Authorized Official

Name: WENDY KIRK
Title or Position: CREDENTIALING SPECIALIST
Credential:
Phone: 414-967-9000