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General NPI Number Information
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NPI Number | 1144385873
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Entity Type | Organization
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Legal Business Name | CHIROPLUS COMPLIMENTARY HEALTH CARE CENTER LLC
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Dates
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Enumeration Date | 12/22/2006
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Last Update Date | 05/24/2011
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Provider Practice Location Address
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Address Line | 505 LAKE STREET
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City | GREEN LAKE
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State | WI
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Zip | 54941
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Country | US
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Telephone | 920-294-3130
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Fax | 920-294-3238
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Provider Business Mailing Address
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Address Line | PO BOX 458
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City | GREEN LAKE
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State | WI
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Zip | 54941-0458
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Country | US
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Telephone | 920-294-3130
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Fax | 920-294-3238
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Authorized Official
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Title or Position | GENERAL PARTNER
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Name | DR. COLLEEN POMPLUN
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Credential | DC
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Telephone | 920-294-3130
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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 | 3020
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License Number State | WI
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