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General NPI Number Information
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NPI Number | 1063832798
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Entity Type | Organization
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Legal Business Name | ACTIVE HEALTH EAU CLAIRE
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Dates
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Enumeration Date | 04/21/2014
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Last Update Date | 04/21/2014
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Provider Practice Location Address
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Address Line | 3521 LONDON RD
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City | EAU CLAIRE
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State | WI
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Zip | 54701-7861
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Country | US
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Telephone | 715-834-6333
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Fax | 715-831-6374
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Provider Business Mailing Address
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Address Line | 3521 LONDON RD
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City | EAU CLAIRE
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State | WI
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Zip | 54701-7861
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Country | US
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Telephone | 715-834-6333
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Fax | 715-831-6374
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Authorized Official
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Title or Position | MEMBER
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Name | JUDY SOBOROWICZ
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Credential | DC
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Telephone | 715-834-6333
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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 | 3207
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License Number State | WI
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Taxonomy #2
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | 3103
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License Number State | WI
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