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General NPI Number Information
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NPI Number | 1083600654
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Entity Type | Organization
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Legal Business Name | DE PERE CHIROPRACTIC CENTER, LLC
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Dates
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Enumeration Date | 09/20/2005
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Last Update Date | 09/03/2025
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Provider Practice Location Address
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Address Line | 820 GEORGE ST
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City | DE PERE
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State | WI
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Zip | 54115-2916
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Country | US
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Telephone | 920-336-2921
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Fax | 920-425-4196
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Provider Business Mailing Address
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Address Line | 820 GEORGE ST
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City | DE PERE
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State | WI
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Zip | 54115-2916
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Country | US
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Telephone | 920-336-2921
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Fax | 920-425-4196
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Authorized Official
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Title or Position | OWNER
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Name | DR. JACESON L. HAUSER
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Credential | DC
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Telephone | 920-336-2921
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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 | WI
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