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General NPI Number Information
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NPI Number | 1053565267
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Entity Type | Organization
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Legal Business Name | ACUPUNCTURE AND CHIROPRACTIC ASSOCIATES OF WISCONSIN, SC
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Dates
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Enumeration Date | 11/14/2008
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Last Update Date | 01/13/2009
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Provider Practice Location Address
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Address Line | 2960 TRIVERTON PIKE DR SUITE 107
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City | FITCHBURG
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State | WI
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Zip | 53711-5896
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Country | US
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Telephone | 608-271-2229
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Fax | 608-271-9515
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Provider Business Mailing Address
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Address Line | 2960 TRIVERTON PIKE DR SUITE 107
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City | FITCHBURG
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State | WI
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Zip | 53711-5896
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Country | US
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Telephone | 608-271-2229
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Fax | 608-271-9515
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. CORDAY LLOYD FEITH
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Credential | D.C.
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Telephone | 608-213-4333
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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 | 3650-12
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License Number State | WI
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