Healthcare Provider Details

I. General information

NPI: 1003950379
Provider Name (Legal Business Name): TORY J. NORDLINDER D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/19/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

835 MAIN ST
NEENAH WI
54956-2254
US

IV. Provider business mailing address

835 MAIN ST
NEENAH WI
54956-2254
US

V. Phone/Fax

Practice location:
  • Phone: 920-727-1234
  • Fax: 920-727-1458
Mailing address:
  • Phone: 920-727-1234
  • Fax: 920-727-1458

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number3195-012
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: