Healthcare Provider Details

I. General information

NPI: 1427160456
Provider Name (Legal Business Name): FALLS HEALING ARTS, S.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/31/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

275 NORTH MAIN STREET
SHEBOYGAN FALLS WI
53085-3315
US

IV. Provider business mailing address

275 STATE ROAD 32
SHEBOYGAN FALLS WI
53085-3315
US

V. Phone/Fax

Practice location:
  • Phone: 920-467-8690
  • Fax: 920-467-0373
Mailing address:
  • Phone: 920-467-8690
  • Fax: 920-467-0373

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number2611
License Number StateWI

VIII. Authorized Official

Name: MRS. MELISSA J DITTBRENDER
Title or Position: INSURANCE MANAGER
Credential:
Phone: 920-467-8690