Healthcare Provider Details

I. General information

NPI: 1780986703
Provider Name (Legal Business Name): DUMOND CHIROPRACTIC, S.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/23/2010
Last Update Date: 11/23/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

165 N. CENTRAL AVE. SUITE 101
RICHLAND CENTER WI
53581-0189
US

IV. Provider business mailing address

165 N. CENTRAL AVE. SUITE 101
RICHLAND CENTER WI
53581-0189
US

V. Phone/Fax

Practice location:
  • Phone: 608-647-2119
  • Fax: 608-647-7539
Mailing address:
  • Phone: 608-647-2119
  • Fax: 608-647-7539

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QH0100X
TaxonomyHealth Service Clinic/Center
License Number1377
License Number StateWI

VIII. Authorized Official

Name: MATTHEW DUMOND
Title or Position: PRESIDENT
Credential:
Phone: 608-647-2119