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General NPI Number Information
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NPI Number | 1013932821
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Entity Type | Organization
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Legal Business Name | SIMPLY CHIROPRACTIC, LLC
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Dates
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Enumeration Date | 07/13/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 2303 SCHNEIDER AVE SE SUITE 150
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City | MENOMONIE
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State | WI
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Zip | 54751-7005
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Country | US
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Telephone | 715-233-1867
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Fax |
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Provider Business Mailing Address
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Address Line | 2303 SCHNEIDER AVE SE SUITE 150
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City | MENOMONIE
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State | WI
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Zip | 54751-7005
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Country | US
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Telephone | 715-233-1867
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Fax |
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Authorized Official
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Title or Position | MEMBER/OWNER
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Name | DR. SHANE C PETERSON
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Credential | D.C.
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Telephone | 715-233-1867
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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 | 3763
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License Number State | WI
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