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General NPI Number Information
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NPI Number | 1033511688
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Entity Type | Organization
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Legal Business Name | VAN ROO FAMILY CHIROPRACTIC LLC
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Dates
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Enumeration Date | 09/25/2014
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Last Update Date | 09/25/2014
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Provider Practice Location Address
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Address Line | 2505 MILTON AVE
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City | JANESVILLE
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State | WI
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Zip | 53545-0441
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Country | US
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Telephone | 608-756-5225
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Fax | 608-756-0506
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Provider Business Mailing Address
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Address Line | 2505 MILTON AVE
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City | JANESVILLE
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State | WI
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Zip | 53545-0441
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Country | US
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Telephone | 608-756-5225
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Fax | 608-756-0506
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. RYAN T VAN ROO
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Credential | DC
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Telephone | 608-756-5225
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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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