Healthcare Provider Details

I. General information

NPI: 1326770785
Provider Name (Legal Business Name): ENCOMPASS CHIROPRACTIC LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/25/2022
Last Update Date: 06/25/2022
Certification Date: 06/25/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

148 MAIN ST
SULLIVAN WI
53178-9665
US

IV. Provider business mailing address

148 MAIN ST
SULLIVAN WI
53178-9665
US

V. Phone/Fax

Practice location:
  • Phone: 414-659-0412
  • Fax:
Mailing address:
  • Phone: 414-659-0412
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM2500X
TaxonomyMedical Specialty Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. CONNOR KEATING
Title or Position: OWNER/ CHIROPRACTOR
Credential: D.C.
Phone: 414-659-0412