Healthcare Provider Details

I. General information

NPI: 1235564055
Provider Name (Legal Business Name): CHIRO-HEALTH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/11/2013
Last Update Date: 09/19/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1370 PABST FARMS CIR UNIT 345
OCONOMOWOC WI
53066-4880
US

IV. Provider business mailing address

1370 PABST FARMS CIR UNIT 345
OCONOMOWOC WI
53066-4880
US

V. Phone/Fax

Practice location:
  • Phone: 262-200-2702
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QH0100X
TaxonomyHealth Service Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. PETER GEARY
Title or Position: CHIROPRACTOR
Credential:
Phone: 262-200-2700