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General NPI Number Information
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NPI Number | 1003132556
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Entity Type | Organization
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Legal Business Name | WAUPACA WELLNESS CENTER LLC
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Dates
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Enumeration Date | 04/08/2010
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Last Update Date | 12/15/2011
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Provider Practice Location Address
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Address Line | 1336 MICHIGAN ST SUITE A
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City | WAUPACA
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State | WI
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Zip | 54981-1648
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Country | US
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Telephone | 715-258-7444
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Fax | 715-258-7844
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Provider Business Mailing Address
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Address Line | 1336 MICHIGAN ST SUITE A
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City | WAUPACA
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State | WI
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Zip | 54981-1648
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Country | US
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Telephone | 715-258-7444
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Fax | 715-258-7844
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Authorized Official
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Title or Position | OWNER
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Name | DR. JEFFREY CLEVE HAMEL
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Credential | D.C.
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Telephone | 715-258-7444
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number | 3702-012
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License Number State | WI
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