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General NPI Number Information
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NPI Number | 1003975038
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Entity Type | Organization
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Legal Business Name | COULEE CHIROPRACTIC CLINIC, S.C.
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Dates
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Enumeration Date | 12/06/2006
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Last Update Date | 09/29/2014
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Provider Practice Location Address
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Address Line | 600 3RD ST N SUITE 201
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City | LA CROSSE
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State | WI
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Zip | 54601-6299
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Country | US
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Telephone | 608-782-6604
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Fax | 608-782-6335
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Provider Business Mailing Address
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Address Line | 600 3RD ST N SUITE 201
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City | LA CROSSE
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State | WI
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Zip | 54601-6299
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Country | US
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Telephone | 608-782-6604
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Fax | 608-782-6335
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. KENNETH H WOODRUFF
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Credential | D.C.
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Telephone | 608-782-6604
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number |
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License Number State |
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