Healthcare Provider Details

I. General information

NPI: 1275860785
Provider Name (Legal Business Name): DAHLSTROMS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/05/2009
Last Update Date: 11/05/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

37 5TH AVE
SHELL LAKE WI
54871-0236
US

IV. Provider business mailing address

37 5TH AVE PO BOX 236
SHELL LAKE WI
54871
US

V. Phone/Fax

Practice location:
  • Phone: 715-468-2319
  • Fax: 715-468-4140
Mailing address:
  • Phone: 715-468-2319
  • Fax: 715-468-4140

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332900000X
TaxonomyNon-Pharmacy Dispensing Site
License Number
License Number State

VIII. Authorized Official

Name: MR. JOHN O DAHLSTROM
Title or Position: PRESIDENT
Credential:
Phone: 715-468-2319