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General NPI Number Information
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NPI Number | 1124194790
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Entity Type | Organization
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Legal Business Name | WAUPACA CHIROPRACTIC CENTER, INC
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Dates
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Enumeration Date | 11/27/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 304 S WESTERN AVE
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City | WAUPACA
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State | WI
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Zip | 54981-5703
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Country | US
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Telephone | 715-258-8211
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Fax |
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Provider Business Mailing Address
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Address Line | 304 S WESTERN AVE
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City | WAUPACA
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State | WI
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Zip | 54981-5703
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Country | US
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Telephone | 715-258-8211
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | MIRIAM LEEAN-RODENZ
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Credential | DC
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Telephone | 715-258-8211
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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 | 3651
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License Number State | WI
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