Healthcare Provider Details

I. General information

NPI: 1003141615
Provider Name (Legal Business Name): ST CROIX CHIROPRACTIC AND WELLNESS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/15/2009
Last Update Date: 10/15/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

520 S. WASHINGTON STREET
ST CROIX FALLS WI
54024-0851
US

IV. Provider business mailing address

1651 N BEAR LAKE DR
DRESSER WI
54009-4633
US

V. Phone/Fax

Practice location:
  • Phone: 715-483-9991
  • Fax:
Mailing address:
  • Phone: 715-483-9221
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number4404-012
License Number StateWI

VIII. Authorized Official

Name: JOY KATHLEEN ZASADNY
Title or Position: OWNER/PRACTIONER
Credential: DC
Phone: 715-483-9221