Healthcare Provider Details

I. General information

NPI: 1063577666
Provider Name (Legal Business Name): STEPHEN JOSEPH BORAK D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/26/2006
Last Update Date: 10/18/2023
Certification Date: 10/18/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

190 HIGHWAY 70
SAINT GERMAIN WI
54558-0665
US

IV. Provider business mailing address

PO BOX 665 190 HWY 70
SAINT GERMAIN WI
54558-0665
US

V. Phone/Fax

Practice location:
  • Phone: 715-479-3261
  • Fax: 715-479-6295
Mailing address:
  • Phone: 715-479-3261
  • Fax: 715-479-6295

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number2760
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: