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General NPI Number Information
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NPI Number | 1144378506
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Entity Type | Organization
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Legal Business Name | OMRO CHIROPRACTIC OFFICE, SC
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Dates
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Enumeration Date | 01/08/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 215 JACKSON AVE
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City | OMRO
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State | WI
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Zip | 54963-1429
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Country | US
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Telephone | 920-685-6788
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Fax | 920-685-0293
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Provider Business Mailing Address
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Address Line | 215 JACKSON AVE
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City | OMRO
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State | WI
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Zip | 54963-1429
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Country | US
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Telephone | 920-685-6788
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Fax | 920-685-0293
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Authorized Official
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Title or Position | DOCTOR OF CHIROPRACTIC
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Name | JEFFREY J BEEM
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Credential | DC
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Telephone | 920-685-6788
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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 | 2327 012
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License Number State | WI
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