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General NPI Number Information
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NPI Number | 1104031764
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Entity Type | Organization
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Legal Business Name | DICIAULA HEALTH SERVICES, SC
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Dates
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Enumeration Date | 05/14/2007
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Last Update Date | 12/29/2015
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Provider Practice Location Address
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Address Line | 213 W WISCONSIN AVE
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City | PEWAUKEE
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State | WI
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Zip | 53072-3435
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Country | US
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Telephone | 262-695-0022
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Fax | 262-695-0011
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Provider Business Mailing Address
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Address Line | 213 W WISCONSIN AVE
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City | PEWAUKEE
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State | WI
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Zip | 53072-3435
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Country | US
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Telephone | 262-695-0022
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Fax | 262-695-0011
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. TAD A DICIAULA
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Credential | DC
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Telephone | 262-695-0022
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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 | 3967-012
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License Number State | WI
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