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General NPI Number Information
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NPI Number | 1093539173
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Entity Type | Organization
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Legal Business Name | CHIROPRACTIC HEALTH CENTER OF WAUPACA LLC, STUART BOELTE SOLE MBR
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Dates
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Enumeration Date | 11/14/2024
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Last Update Date | 11/18/2024
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Provider Practice Location Address
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Address Line | 1326 ROYALTON ST
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City | WAUPACA
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State | WI
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Zip | 54981-1609
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Country | US
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Telephone | 715-258-8288
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Fax | 715-258-7195
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Provider Business Mailing Address
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Address Line | 1326 ROYALTON ST
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City | WAUPACA
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State | WI
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Zip | 54981-1609
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Country | US
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Telephone | 715-258-8288
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Fax | 715-258-7195
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Authorized Official
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Title or Position | CHIROPRACTOR
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Name | DR. STUART JOHN BOELTE
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Credential | DC
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Telephone | 715-258-8288
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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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