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General NPI Number Information
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NPI Number | 1083700561
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Entity Type | Organization
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Legal Business Name | BARABOO CHIROPRACTIC OFFICE INC
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Dates
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Enumeration Date | 10/04/2006
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Last Update Date | 10/02/2014
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Provider Practice Location Address
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Address Line | 1030 8TH ST
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City | BARABOO
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State | WI
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Zip | 53913-1850
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Country | US
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Telephone | 608-356-2127
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Fax | 608-356-1292
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Provider Business Mailing Address
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Address Line | 1030 8TH ST
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City | BARABOO
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State | WI
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Zip | 53913-1850
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Country | US
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Telephone | 608-356-2127
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Fax | 608-356-1292
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Authorized Official
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Title or Position | OWNER
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Name | STEVEN M WITTERS
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Credential | D.C.
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Telephone | 608-356-2127
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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 | 1559-012
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License Number State | WI
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